Edgemont House

Edgemont House is a residential service providing personal care for up to 14 older people some of whom are living with dementia. The service consists of an adapted building, which includes individual bedrooms, communal spaces and an accessible outdoor space. At the time of our inspection there were 13 people using the service.

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

People and their relatives told us people were safe with the care and support they received from the service. However, despite positive feedback we found shortfalls with the management of medicines, staff recruitment and quality assurance systems which placed people at increased risk of harm.

Systems in place to monitor the quality and safety of the service did not identify and address the shortfalls we found during the inspection.

Medicines were not managed safely in line with national guidance. Safe staff recruitment procedures were not being followed.

People were supported by a consistent team of staff who knew them well, there were enough staff to keep people safe and meet their needs.

The service had systems in place to assess people’s risks, people were protected from the risk of abuse. Staff followed safe infection prevention and control procedures.

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 management team promoted a positive culture, staff told us they were supported and morale within the staff team was good. People and their relatives told us they were satisfied with the service.

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 November 2017). There has been one targeted inspection since this inspection, published 20 May 2021. This did not change the rating.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 changed from good to requires improvement based on the findings of this inspection.

Enforcement

We have identified breaches of regulation in relation to Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 19 (Fit and proper persons employed) at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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

We found the following examples of good practice.

Various visitor arrangements for family were constantly reviewed and supported based on government guidelines. Following new, recent guidance the provider and manager were developing a procedure and policy to support people to be able to leave the home whilst maintaining their safety. One person spoke with us about how she had felt ‘very safe’ in the home and was enjoying her relatives visits. We saw a family member supporting their loved one during their visit. Prior to any visiting people were informed of the procedures they should expect on arrival. People were asked not to visit the service if they displayed any symptoms related to Covid19. Prior to entering they received a lateral flow test (LFT). Everyone provided contact details to support the track and trace system. Visitors were shown to the area of the home they were visiting, by the shortest and most direct route.

People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained good. The vaccination programme for people and staff had been well received.

Social distancing was encouraged throughout the home. Where this was not achievable, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly. This had particularly applied to a person who had dementia and found it difficult to understand restrictions. The manager had sought help from the local authority and Public Health England which she had found useful.

From the onset of the pandemic staff had put people’s best interests at the heart of these difficult times. All staff recognised their responsibility to protect the people they cared for and how crucial it was that when they were not at work, they respected and followed government guidelines to reduce their own exposure to risks. The manager was very proud of all staff, she recognised and celebrated their efforts and their values as a whole team. Since the pandemic they had created a wellbeing telephone app group to support each other. This included general discussions about how staff were feeling, did they require any extra support and were there any concerns.

The emotional wellbeing of people and their families had been supported throughout the pandemic. The whole team ensured contact and support was maintained through various initiatives. Staff were sensitive to people’s feelings including anxiety and sadness. Positive activity provision continued, including celebrating special events. One to one interaction with people had also increased and people had enjoyed this individualised approach in addition to their activity programme.

There were clear policies, procedures and contingency plans in place. Audits were undertaken, and actions were taken to ensure improvements were made. Staff had received Infection Prevention and Control (IPC) training and regular updates were provided. Spot checks took place to check staff understanding and compliance with the use of Personal Protective Equipment and IPC practices.

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.

At our last inspection in May 2016 we rated the service overall as Requires Improvement. At that inspection we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and, a breach of section 33 of the Health and Social Care Act 2008.

Following that inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of those regulations. At this inspection we saw the provider had taken action as identified in their action plan. As a result improvements had been made. As a result of this inspection the service has an overall rating of Good.

Why the service is rated Good

The appointment of the registered manager had helped rectify previous poor management of the service. An increase in the provider’s oversight meant that a significant number of improvements had been made to help ensure that people were safe and received quality care.

The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage monitor and review these.

People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Staff had the knowledge and skills they needed to carry out their roles effectively. They were supported by the provider and the registered manager at all times. Staff had completed nationally recognised qualifications in health and social care and others were in the process of completing this.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. People who used the service felt able to make requests and express their opinions and views.

People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions a process of best interest decision making had been followed that was consistent with the principles of the Mental Capacity Act 2005 (MCA)..The Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People benefitted from a service that was well led. The vision, values and culture of the service were clearly communicated to and understood by staff. The registered manager had implemented a programme of ‘planned growth’ that had been well managed and they were committed to continuous improvement.

The registered manager demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service.

A manager had been appointed in September 2015; however they had not registered with the Commission. 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.

Despite the positive views of people who used the service improvements were required. We could not be satisfied that people were always safe because the care staffing levels did not take into account unforeseen circumstances or emergencies. The way staffing levels were considered needed to be reviewed to take into account dependency levels of people who required care and support.

Monitoring the quality of the service had lapsed; they had not been consistently applied and were not robust enough to ensure quality and safety. People’s views and experiences were not sought through quality assurance systems. The provider lacked knowledge and understanding about their legal obligations, including conditions of registration.

People were ‘happy and content’ living at Edgemont House and we received positive comments about their views and experiences during our visits. People said staff were ‘attentive and angels’. One person said, “I feel like this is my home and I have a big family”.

Staff were knowledgeable in safeguarding procedures and how to identify and report abuse. People were supported by the recruitment policy and practices to help ensure that staff were suitable.

People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People received a varied nutritious diet, suited to individual preferences and requirements. Mealtimes were flexible and taken in a setting where people chose. Staff took prompt action when people required access to community services and expert treatment or advice.

People enjoyed receiving visitors and had made “friends” with people they lived with. They were relaxed in each other’s company. Staff had a good awareness of individuals' needs and treated people kindly. Staff were knowledgeable about everyone they supported and it was clear they had built up relationships based on trust and respect for each other.

People moved into the service only when a full assessment had been completed and the registered manager was sure they could fully meet a person’s needs. People’s needs were assessed, monitored and evaluated. This ensured information and care records were up to date and reflected the support people wanted and required.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We have also made recommendations in the report where improvements are required. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, seeking experience and views from people who used the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager was in the process of updating these due to the recent changes in legislation. Additional training was also being sought so staff had up to date knowledge. There were effective systems in place where people did not have capacity and best interest decisions were made through a multi-agency approach.

People were safe from the risks of mismanagement of medicines, because policies and procedures were in place and followed by staff. They had been trained and supervised appropriately to ensure they were competent to administer medicines.

People were safe because the manager ensured there was enough staff to meet people's needs. The manager was able to demonstrate their responsibilities in recognising changing circumstances within the service and used a risk based approach to help ensure staffing levels and the staff skill mix was effective.

Is the service effective?

People's health and welfare was protected and promoted because the service sought expertise and support from other health and social care services that people required in order to meet their needs effectively.

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People were involved throughout these processes. This ensured their needs were clearly identified and the support they received was meaningful and person centred.

Is the service caring?

Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. We saw people were receiving support in a sensitive way during our visit.

The manager, deputy manager and staff were knowledgeable about people's lives before they moved into the home. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.

There was a constant interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company. People referred to the Edgemont as 'home from home'.

People looked well cared for, they were dressed in clothes that had been ironed, their hair was combed, men had been shaved, people had their hearing aids in and they were wearing their glasses.

Is the service responsive?

People using the service and their relatives completed surveys throughout the year. Where suggestions and ideas were raised these were addressed promptly by the manager.

The systems in place for auditing the service were effective. We saw evidence where improvements had been made as a result of the audits that had been completed.

Is the service well-led?

The service was well-led because there was a management team and on-call arrangements were in place to cover evenings and weekends.

The manager, deputy manager and staff continued to look at the needs of people who used the service and ways to improve these for people. One way they had achieved this was through monthly 'residents' meetings. This meant that people had been empowered to make positive changes.

Some people remembered us from a previous visit and they were happy to see us again. We spoke with five people individually and spent time talking and observing people in communal areas.

There was a happy, homely atmosphere throughout the day. People were relaxing and socialising in communal areas, spending private time in their rooms, one person had a visitor and we saw some people spending time in the garden.

One person we spoke with had spent two weeks at the home for a rest. They explained to us that they had enjoyed their stay so much and decided to live in the home permanently. They told us 'I am enjoying the company, the staff and the food. I have made some lovely friends, the staff are so kind and we are always laughing'.

It was a positive visit and we found that the provider was compliant in all five outcomes that we looked at.

People looked well and were spending time in the lounge and conservatory. Some were enjoying the privacy of being in their own rooms and people were walking freely around parts of the home.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people who lived at the home received.

People were positive about their experiences. Comments included, "I have a lovely clean room and I do exactly what I want", "The staff are all very good' and "We have excellent staff and all concerns are listened to and acted on'.

The manager had introduced a comments book for people to write about their experiences when they had visited the home. People wrote, 'Lovely place, lovely staff, keep up the good work', 'very happy here it's like a five star hotel' and 'I enjoy coming here because of the happy atmosphere, I am sure we could not find a better home'.