We carried out a review of the data available to us about Edward House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Edward House, you can give feedback on this service.
Edward House is a residential care home providing accommodation and personal care for up to 12 younger adults with learning disabilities and/or an autistic spectrum disorder. There were 12 people living at the service at the time of the inspection. Four people lived in separate flats, two located in the main house and two in the grounds, close to the main house.
People’s experience of using this service and what we found
The service had made improvements to ensure risks to people, such as those related to behaviour, epilepsy and choking, were managed safely. Support plans and emergency protocols were in place to guide staff in supporting people safely. People were supported to receive their medicines safely and as prescribed. There were enough staff to meet people’s needs. Systems were in place to safeguard people and to protect people, staff and visitors from catching and spreading infections.
The provider and registered manager continued to improve the culture and quality of the service. Time was needed for the service and provider’s monitoring systems to become fully effective in identifying all quality concerns in the service.
The staff spoke positively about the leadership provided by the new registered manager. The registered manager and locality manager had met with families to gain their feedback and this was being acted upon. Supportive meetings had been arranged for the staff team and their views and challenges were understood and responded to.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of safe and well-led, this service was able to demonstrate how they were currently meeting the underpinning principles of Right support, right care, right culture. People’s feedback was used when planning their care and staff were working on new activity plans to support them to follow their individual interests and hobbies. People’s independence was encouraged and they were involved in preparing their own meals where possible. People were supported to access facilities in their local community as these re-opened. The managers at the service and staff described their priority as being to deliver person centred care, that met people’s individual needs.
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 4 November 2020) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 1 and 5 October 2020. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and the governance of the service.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Edward House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service. If we receive any concerning information we may inspect sooner.
Edward House is a residential care home providing accommodation and personal care for up to 12 people with learning disabilities and autism. At the time of the inspection 12 people were living in the home.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes.
The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People's experience of using this service and what we found
Risks to people had been assessed and support plans and emergency protocols were in place to guide staff in supporting people safely. However, incident, accident and seizure records had not been reviewed in a timely way to ensure care had been delivered safely and to ensure any new risks could be identified. Improvement was needed to ensure people with epilepsy were always supported safely. This included ensuring people always received their medicines as prescribed.
Other risks to people, including anxiety related behaviours were managed well and people benefited from a spacious homely environment that met their needs. People had enough staff to support them and had opportunities to go out.
Systems in place to monitor and improve the quality and safety of the service had not always been operated effectively to ensure people received a safe service. A lack of consistent strong leadership at Edward House had meant the need to embed provider governance systems, noted at our last inspection, had not been achieved.
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 (report published 18 February 2020).
Why we inspected
We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about people’s epilepsy management. A decision was made for us to inspect and examine those risks.
We inspected and found there was a concern with the support provided to some people living with epilepsy, so we widened the scope of the inspection to become a focused inspection, which included the key questions of Safe and Well-led.
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 coronavirus and other infection outbreaks effectively.
Follow up
The service’s overall rating has deteriorated to Requires Improvement. We will meet with the provider after this report is published, to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Edward House is a residential care home providing accommodation and personal care to 12 people aged 18 and over. There were 11 people being supported at the home at the time of the inspection, including two people who lived in separate flats situated close to the main home.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. However further improvements were needed to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people. Eleven people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
This was a focused inspection as anonymous concerns had been raised with the CQC about the quality of care people received and some restrictive practices. This inspection focused on ‘Is the service safe?’ and ‘Is the service well led?’
The home was being managed by an interim manager while the provider recruited a new manager to be registered with CQC. During their time in post, the manager had found that the quality of care and regulatory requirements had not been sustained since our last inspection of Edward House. They had identified shortfalls in the management of people’s care; care and medicine records and found that staff development had not been always maintained for some staff.
They were working on and implementing a plan of action to address gaps in the service and improve the quality of people’s lives. For example, plans were in place to review and improve the details of people’s care and risk management plans. The provider was taking action to review the safety of the medicine management processes.
Staff and relatives confirmed that they had observed positive changes in the service as a result of the interim manager. However further time was needed to ensure that the actions being taken would be fully implemented and sustained.
People who lived at Edward House had complex needs and required the individual support of staff during the day and accessing the community. The provider was recruiting new staff to reduce the number of agency staff and had plans in place to improve staff rostering, professional development and accountability.
Relatives reported that they felt their relatives were safe at Edward House. Staff were aware of their responsibility to report any safeguarding concerns.
The service didn’t always consistently apply the principles and values of Registering the Right Support and other best practice guidance. However, progress was being made to 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.
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 4 January 2019 )
Why we inspected
We received concerns in relation to the management of people’s care and restrictive practices. As a result, we undertook a focused inspection to review the Key Questions of ‘Is the service safe and Well-led’ only.
We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.
The overall rating for the service has remained Good, however we have found evidence that the provider needs to make improvement. Please see the ‘Is the service well led?’ section of this full report. We will check the provider’s progress and impact on people during our next planned comprehensive inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Edward House on our website at www.cqc.org.uk.
The care service has been developed and designed in line with the values which underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen- CQC Registering the Right Support policy.
The service had a registered manager, as required. 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. The registered manager was present during the course of our inspection.
At our previous inspection on 9 and 10 October 2017, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, and good governance. The overall rating for the service was 'Requires Improvement.' As a result of this inspection, we imposed conditions on the provider's registration. The provider was required to submit monthly reports to us, setting out how they were monitoring the quality and safety of care provided.
At this inspection, we found the provider was no longer in breach of these Regulations and the rating had improved to Good.
Why the service is now rated Good:
The provider had made changes to the management structure at the home and a new registered manager was in post. Staff welcomed the new structure and spoke of its benefits. Relatives, staff and healthcare professionals gave consistently positive feedback about the running of the service and the improvements introduced by the registered manager.
People's independence was encouraged. Where people had relied on staff for daily living skills, they had now developed and were able to actively do more for themselves.
A range of communication aids were used so that people were able to express their views and be involved in decisions about their day-to-day care.
The registered manager and the staff team saw people's potential and continually found ways to help people to progress and develop. People had a renewed interest in their individual hobbies and interests.
People received their medicines safely and in line with the prescriber's guidance. De-escalation methods were exhausted in the first instance before using medicines to stabilise people's mood, and there had been a reduction in the use of antipsychotic medicines.
People were part of their local community. People were supported to maintain relationships with those important to them, and to develop new relationships also.
People's rights were protected, in line with the Human Rights Act and the Mental Capacity Act. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Staff received ongoing training and development in their roles. Bespoke training was arranged to enable them to meet people's individual care and support needs.
Complaints, concerns and feedback were captured and responded to and were used as a way to continually improve the quality and safety of care provided.
Staff understood people well, including their health conditions and needs, as well as their personalities and preferences. Support plans and risk assessments were reflective of people's needs, and were reviewed to ensure they were up-to-date.
When we previously inspected the service on 4 and 5 April 2017 we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service 'Inadequate' overall and the service was placed in special measures. To support the provider to make the necessary improvements we issued a Warning Notice and imposed two conditions on their registration. The provider was required to undertake regular audits to monitor quality and risks in relation to the management of the service and staff, and support of people. They had to send a monthly report to CQC detailing the audit dates, the outcomes of these and any actions taken or to be taken as a result.
At this inspection we found the provider had action taken to address most of the concerns we had identified. Sufficient improvement had been made for the provider to meet the requirements of six of the eight previously breached regulations. More time is required for the provider to complete their action plan and test out the robustness of the improvements and systems in place to ensure it will be able to continue to provide an improved service. The provider would need to sustain the improvements made before people could always be confident that they would receive a high standard of quality individualised care that always met their needs and ensured their safety. Following this inspection the service was rated ‘Requires Improvement’ overall. It has not been rated as 'Inadequate' for any of the five key questions and has therefore been taken out of special measures.
Some further improvement was needed before the provider met the requirements relating to Safe care and treatment and Good governance. This included ensuring all staff would be familiar with people’s risk management strategies and action would always be taken promptly to keep people safe when accidents and incidents occurred. Regular audits were now being completed; however improvements were needed to monitor the effective operation of the service’s safety incident procedures. People’s satisfaction with their care had not been routinely sought for a period of time. People had not always been given a regular opportunity to discuss any concerns or provide feedback about their care experience so that improvements could be made when needed.
There was no registered manager in post. The registered manager had not been working at the home since January 2017 and de-registered with CQC in April 2017. 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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The provider had employed an ‘acting manager’ who had been working at the home for six weeks at the time of our inspection. They were starting the process of registering as the manager with CQC. Relatives were concerned that a consistent manager had not been in place in the home for some time and was beginning to lack confidence in the provider’s ability to establish a strong management team. There were mixed feedback from relatives about the care and support people received.
Following our previous inspection staff had been provided with training on how to recognise abuse and how to report allegations and incidents of abuse. Staff confirmed they had attended safeguarding training. It was clear that people were accessing health professionals as each appointment was now recorded in an individual health file that had been implemented. Complaints were documented; however relatives told us they didn’t always feel listened to when raising issues and concerns. Staff were receiving regular supervisions. Staff training had improved and a matrix was available to show when training was due to expire and training updates had been booked. Competency checks were being completed to ensure staff understood the training they had attended. The premises looked cleaner and more homely and new carpets had been laid in the communal areas.
Staff were able to complete an induction when they first started working at the home. This was a mixture of face to face training, online training and shadowing more experienced staff. The Care Certificate had been introduced and newer members of staff were completing this as part of their induction.
Maintenance issues had been addressed and the building was in a better state of repair. People’s bedrooms were cleaner and new carpets had been laid in the hallway. Systems were now in place to monitor and take appropriate action promptly in relation to on-going maintenance.
Daily notes had improved and a new format had been introduced which contained more relevant information; however these were still brief at times and did not give sufficient detail about what people had been offered to and what they had actually done.
Medicines were stored safely in a locked cabinet within a locked room for medicines. Staff had received training to administer people’s medicines safely. The acting manager had completed a medicine audit three days prior to our inspection. They had identified some shortfalls including people’s medication files were missing information and some medicines were out of date. On the second day of our inspection we found all the shortfalls they had identified had been addressed.
Staff received regular supervision which enabled the acting manager to formally monitor staff performance and provide staff with support to develop their skills and knowledge. Appraisals were booked for all staff. The acting manager told us there had been a delay in booking them due to them needing to know staff well before setting goals and targets.
There was an effective recruitment and selection process to check that potential new staff were suitable to work with people living at Edward House. This was followed and helped to ensure that only suitable staff were employed.
Staff had a good understanding of supporting people with dignity and respect. They told us how they ensured people’s dignity was respected when supporting people with their personal care tasks such as showering.
Staff were positive about the relationships they had with people. Staff told us that the recruitment of more permanent staff members who had been employed had improved things for people living at Edward House.
Staff attended regular team meetings. Staff explained regular meetings gave the team consistency and a space to deal with any issues
We identified two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will monitor the action taken by the provider to meet these two regulations through the positive conditions we imposed on the provider’s registration following our April 2017 inspection.
There was no registered manager in post. The registered manager had not been working in the home since January 2017 when an internal quality audit by the provider had identified some concerns. The registered manager had de-registered with CQC on 11 March 2017. 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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The provider had employed an ‘acting manager’ from another service who had been working at Edward House for two months.
The service was the subject of on-going monitoring by the local authority. This was because when they visited in 2016, they found that the service required improvement. An action plan was put in place with specific actions required and a timeline for this. This was still in progress during our inspection.
We received information prior to this inspection from a health and social care professional telling us that people were at risk. This was because staff were not adequately trained and people were being placed at risk due to high numbers of agency staff being employed. The local authority had completed a visit to the service on 22 March 2017 and found concerns relating to people’s safety. Our inspection highlighted shortfalls where some regulations were not met. We also identified further areas where improvement was required.
People did not receive a service that was safe. The provider did not have effective systems to assess, review and manage risks to ensure the safety of people.
Sufficient numbers of staff were available to keep people safe; however a high number of agency staff were being employed. This reduced staff consistency and this in turn negatively impacted on people’s care. Some people were not being supported to reach their full potential.
The service did not provide effective care and support. Staff had not received suitable training enabling them to effectively support the people living at Edward House such as people living with autism or with behaviours that may challenge. Many of the staff team had not attended mandatory training courses such as adult safeguarding, face to face first aid, MCA and DoLS and infection control.
There were some positive comments from relatives and health professionals about the care provided and the staff members who cared for their loved one.
The service was not responsive to people’s needs. Support plans and risk assessments were out of date and lacked detail required to provide consistent, high quality care and support. People did not always have sufficient activities to support them to socialise and lead a fulfilling life. Complaints were not documented or dealt with appropriately.
The provider had governance systems in place to monitor the quality of the service provided. However, these systems had not identified the concerns we found around recording of information and assessing risks.
Staff we spoke with said they felt anxious about the service provided and that the morale was low. We observed staff trying to support people in a caring and patient way during the inspection; however staff did not appear to know the people they were caring for well. Staff were not respecting people’s choices on two occasions.
The service was not well led. The registered manager had left the service along with many staff members. The registered manager and provider had governance systems in place to monitor the quality of the service provided. However, these systems had not identified the concerns we found around recording of information, identifying staff training needs, ensuring staff were treating people with dignity and respect and assessing risks.
We found a number of 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 back of the full version of this report.
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.
This inspection took place on 24 and 25 September 2015 and was unannounced. Edward House provides accommodation and personal care for up to 12 adults with a learning disability or autism spectrum condition in four individual flats and eight bedrooms with shared facilities. Twelve people were living at the home when we visited and they had a range of support needs including help with communication, personal care, moving about and support if they became confused or anxious. Staff support was provided at the home at all times and people required the support of one or more staff when away from the home.
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 and associated Regulations about how the service is run.
People were supported by a caring staff team who knew them well and treated them as individuals. Staff worked hard to understand what was important to people and to meet their needs despite the difficulties some people had communicating. Staff were patient and respectful of people’s unique preferences.
Staff supported people to take part in activities they knew matched the person’s individual preferences and interests. People were encouraged to make choices and to do things for themselves as far as possible. In order to achieve this, a balance was struck between keeping people safe and supporting them to take risks and develop their independence. Some people had complex needs and these were met by staff in collaboration with health and social care professionals.
Staff felt well supported and had the training they needed to provide personalised support to each person. Staff met with their line manager to discuss their development needs and action was taken when concerns were raised. Staff understood what they needed to do if they had concerns about the way a person was being treated. Staff were prepared to challenge and address poor care to keep people safe and happy.
The registered manager received support and supervision from the provider. They conducted quality audits that were then checked by the provider. Learning took place following any incidents to prevent them happening again. Complaints were acted on but not recorded to allow future review and learning.
The service had a system in place to make sure people who were not able provide consent for aspects of their care treatment were protected and the home acted in their best interests.
An effective system was in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.
The manager had been at the service for about five months and was in the process of reviewing and updating people's care records. He told us of his plans to improve the service for people who lived at Edward House.
We observed staff treating people with respect and offering them choices.
People were able to go on outings and undertake activities with the support of staff; as people were out in the community during our visit.
A safe system was in place for management of people's monies.
Staff told us it was a good place to work as they had access to training to maintain and learn new skills. They felt supported by their staff team and the manager.