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Inspection carried out on 28 January 2020

During a routine inspection

About the service

Eden Cottage is registered to accommodate up to three people and provides care and support for people with learning disabilities. The service is split over two floors which were accessible by stairs. There were three people using the service at time of inspection.

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.

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

People told us they were happy, felt safe. Professionals said that staff had a good understanding of people’s needs and preferences. Risks had been identified and measures put in place to keep people safe from harm. Medicines were managed safely and administered by trained staff.

Staff listened to what people wanted and acted quickly to support them to achieve their goals and outcomes. Staff offered people solutions to aid their independence and develop their skills.

Staff were well trained and skilled. They worked with people to overcome challenges and promote their independence. The emphasis of support was towards inclusion and enabling people to learn essential life skills. Equality, diversity and human rights were promoted and understood by staff.

People, and professionals described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. 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.

People received pre-admission assessments and effective person-centred support. The service was responsive to people’s current and changing needs. Regular reviews took place which ensured people were at the centre of their support.

People, professionals and staff spoke highly about the management and staff had a clear understanding of their roles and responsibilities. The team worked together in a positive way to support people to achieve their own goals and to be safe.

Checks of safety and quality were made to ensure people were protected. Work to continuously improve the service was noted and the registered manager was keen to make changes that would impact positively on people's lives.

The service applied the principles and values of 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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 27 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 12 June 2017

During a routine inspection

This inspection took place on 12 June 2017 and was unannounced.

Eden Cottage provides accommodation and support for up to three people who may have a learning disability, autistic spectrum disorder or physical disabilities. At the time of the inspection three people were living at the service. All people had access to a communal lounge/dining area, kitchen, a shared downstairs bathroom and a garden. Two people had bedrooms on the ground floor; one person had a bedroom and bathroom on the first floor. The service had its own vehicle to access facilities in the local area and to access a variety of activities.

At the previous inspection Eden Cottage did not have a registered manager in post. At this inspection there was a registered manager working at the service. 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.

We carried out an unannounced comprehensive inspection of this service on 4 May 2016. Three breaches of regulations were found. We issued requirement notices relating to need to consent, person centred care and good governance. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found the breaches in the regulations had been met.

At the previous inspection some documentation in care plans had not been updated to reflect people’s current needs and was conflicting. At this inspection improvements had been made and majority of information in peoples care plans had been updated to reflect their present needs. However, on a couple of occasion’s recent changes to peoples care was not updated. Staff did know about the changes and people received the care that they needed. This was an area for further improvement. People were satisfied with the care and support they received.

The MCA provides the legal framework to assess people's capacity to make certain decisions, at a certain time. When people were assessed as not having the capacity to make a decision, a best interest decision was made, involving people who knew the person well and other professionals.

At the previous inspection the provider had failed to comply with the requirements of the Mental Capacity Act. At this inspection improvements had been made. Mental Capacity assessments and best interest decisions had been completed for less complex decisions to meet the requirements of the Act. Staff had received further training so they would understand how to comply with ‘The Act’.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance.

At the previous inspection when people required their fluid intake to be monitored total amounts of daily fluid to aim for were not agreed. At this inspection improvements had been made. The total amount of fluid to aim for to give a person over a 24 hour period was agreed. Staff recorded the amount of fluid people drank and monitored and reported to make sure people were drinking enough.

There had been no new people at the service for a long time and there were no plans for any new admissions. But if a new person was thinking about coming to live at the service their support needs would be assessed by the registered manager t

Inspection carried out on 4 May 2016

During a routine inspection

This inspection took place on the 04 May 2016 and was unannounced. Eden Cottage provides accommodation and support for up to three people who may have a learning disability, autistic spectrum disorder or physical disabilities. At the time of the inspection three people were living at the service. All people had access to a communal lounge/dining area, kitchen, a shared bathroom and well maintained garden. Two people had bedrooms on the ground floor; one person had a bedroom on the first floor.

The service did not have 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. The registered manager had left the service in January 2016 and was in the process of de-registering with The Commission. The provider had appointed a manager to manage the home. They had submitted an application to register with the Care Quality Commission (CQC) at the time of our inspection. The new manager was present throughout the inspection.

Eden Cottage was last inspected on the 28 October 2014 and had been rated as requires improvement at that inspection. Two breaches of our regulations were found, relating to effective and accurate record keeping and staff numbers. At this inspection we found that improvements had been made in these areas, but further improvements were needed to record keeping.

Some documentation was conflicting and out of date. The acting manager had taken steps to start improving and updating some of the paperwork. The documentation which had been updated was of good quality.

Mental Capacity assessments and best interest decisions had not been completed for less complex decisions to meet the requirements of the Act. Further training was required in this area so staff would understand how to comply with The Act.

When people required their fluid intake to be monitored total amounts of daily fluid to aim for were not agreed. Although peoples safety had not been compromised, better recording of this area would further reduce the risk of harm. People could choose what meals, snacks and drinks they would like. When people could not verbally communicate this there was clear description in their care files outlining what they liked and disliked and how staff could recognise this by their body language.

The provider’s internal audits had highlighted that some training needed to be refreshed and action had been taken to obtain updated training for staff.

Staffing levels had improved since the last inspection which meant people were able to pursue more activity and interests to benefit their well-being. During the inspection all people went out to do various activities of their choice. Staff planned activities with people with consideration for their personal interests.

New staff underwent an induction which prepared them for their role and did not work unsupervised until assessed as competent to do so. Safe and robust recruitment process were in place to ensure people were supported by appropriately checked staff.

People’s health needs were responded to promptly and healthcare professionals said they felt well informed about people’s needs when they changed.

People were helped to complain and staff would support people who were unable to use the easy read complaints policy by understanding what their body language meant if they were unhappy. Relatives said they felt confident they could complain if they were unhappy and they would be listened to.

Staff demonstrated caring attitudes towards people and showed concern for people’s welfare. When people required to be supported with their anxieties staff did this in a patient and compassionate manner.

The acting manager understood the key challenges of the service and had star

Inspection carried out on 28 October 2014

During a routine inspection

We undertook an unannounced inspection of this home on 28 October 2014. We last inspected the service on 21 October 2013 where no concerns were identified. This service provides accommodation and care to three people with learning disabilities and is located in a residential area of Dymchurch, within reach of local amenities, shops and public transport.

There was no registered manager in place at the time of the inspection. The new manager was in the process of applying for their manager registration with the Care Quality Commission (CQC). 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.

We spoke to two out of three people who had lived in the home for many years. They told us they liked living there and had everything they needed. Some people had been supported to develop their independence skills and could travel outside the home independently, but further promotion of independence was sometimes slow to be put into practice.

Recruitment files showed that the provider ensured appropriate checks were made before staff commenced work, but the content of staff records were inconsistent and information difficult to find. Staff demonstrated a respectful, caring and friendly attitude towards the people they supported, and consulted them about all aspects of their day to day care and support. Staff understood about any special needs people had but care records did not always reflect the practice of staff.

Staffing levels were enough to support the day to day basic care needs of people when in the home, and when at home people told us they did the things they wanted to do. People were supported to access the community but more staffing hours were needed to ensure this happened more frequently.

A staff member said they felt well supported and had opportunities through individual meetings with their manager and through staff meetings to express their views. They had received an induction into their role but this was poorly recorded. Staff had received essential training to ensure they had the knowledge and skills to keep people safe. Accidents and incidents were reported and acted upon appropriately. People were supported to maintain links with their families, and external relationships were supported but not well recorded.

Minor improvements were needed to ensure that the systems in place for the management of medicines were safe. Records showed that policies and procedures were kept updated to inform staff of current best practice. A range of audits were in place to check that service quality was maintained and the home’s compliance was monitored regularly by the provider.

The home was well maintained, and provided a homely, comfortable and visibly clean environment for people to live in. Each person had been enabled to personalise their own space to reflect their interests and tastes.

Staff told us and records showed that all relevant safety checks were in place. Staff undertook assessment of risks to ensure measures were implemented that kept people safe from harm and these were kept under review.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to 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.

Inspection carried out on 21 October 2013

During a routine inspection

We found evidence that the provider was working in cooperation with both staff and people maintaining a safe and suitably secure environment. This was confirmed on observation of the premises and talking to people and staff.

There were three people in the home when we arrived at the inspection and two members of staff. One staff member had come over to help following an overnight at the adjacent home. We saw that staff discussed concerns and anxieties with people.

We observed two people going out for the day. One person had their medicine with staff supervision, collected a mobile phone and went out independently. The last person was going out later with a member of staff. This showed us that staff listened and that people were supported in their day to day choices.

Staff understood people's needs and methods of communication. There were enough staff to support people's needs safely and in the way they preferred.

Inspection carried out on 8 February 2013

During a routine inspection

Three people were living at the home at the time of the inspection. Two people were out with staff for the day for activities. One person was present for part of the inspection,we spoke with them and the registered manager who was present for the inspection. As no staff were present we telephoned the home on the next weekday and spoke with two members of staff to gain their views.

People were treated with respect and dignity. Records showed that they were supported to make decisions about their day to day lives such as what to do and what to eat and staff respected their choices.

A person said they liked the staff and staff were kind and polite towards them. They said that staff supported them to do the things they liked and with tasks that they needed help with. They said �Staff help me with my money� and �To have days out�.

Staff understood people�s needs and their methods of communication. People�s health care needs were met and they were supported to keep in contact with health care professionals.

People were supported to be as independent as they could and to learn new skills. People could make their own light meals if they chose to. They helped with their laundry and other household tasks and to clean and tidy their rooms.

There were enough staff on duty to support people safely and in the ways they preferred. The organisation had processes and procedures in place to regularly check on the quality of the service people received and to keep them safe.

Reports under our old system of regulation (including those from before CQC was created)