Archived: Edenvale Nursing Home

• The quality of care people received had significantly deteriorated since the last inspection.

• People had been placed at risk of avoidable harm. Medicines were poorly managed, placing people at risk.

• The culture in the service was poor. Staff were task orientated and supported by a management team who lacked clear oversight and knowledge of what was happening in the service.

• Some people had experienced harm because of poor practice and ineffective governance systems and processes.

• The service met the characteristics of inadequate in all areas we inspected.

• Please see more information in Detailed Findings below.

Rating at last inspection: The service was last rated Good, published on 17 May 2018.

About the service:

Edenvale Nursing Home is a care home that was providing personal and nursing care to 28 people at the time of the inspection. It is registered to provide a service to older people who may be living with dementia, physical disability and mental health needs.

Why we inspected:

This inspection was brought forward in response to incidents that had occurred in the service and concerns that had been raised about the safety and management of the service. At the time of the inspection we were aware of incidents being investigated by third parties.

Follow up:

Following the inspection we referred our concerns to the local authority responsible for safeguarding. In addition, we requested an action plan and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

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.

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. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

People’s experience of using this service:

At our last inspection we found serious concerns. At this inspection we found that insufficient improvements had been made. The service remained unsafe at times and not well led.

Insufficient action had been taken to ensure that where people were at risk as a result of their conditions or the care they needed, the risks were assessed, understood and plans implemented to reduce these. This included not seeking expert support in a timely manner.

Processes to keep people safe from abuse were not operated effectively because internal reporting did not always take place appropriately. Recruitment practices did not ensure people were safe because the provider had not always ensured appropriate pre- employment checks were carried out. Feedback from people was that staffing levels and deployment did not meet their needs and we have made a recommendation about this.

Staff were on occasions, task focused, did not always respect people’s dignity and people’s preferences and wishes were not always known or detailed in care plans. Where they were recorded these were not always adhered to. There was a lack of evaluation of care, meaning concerns were not identified.

Systems had not been effective in identifying shortfalls and unsafe practices. Governance systems failed to identify people were not always treated with dignity, equality and respect. Insufficient action had been taken to address the poor culture in the home because leaders lacked an awareness of their responsibilities and of the concerns in the home. As a result, safe standards of care were not consistently delivered.

As insufficient improvements had been made the service remains rated overall Inadequate and will continue in special measures.

Rating at last inspection: Inadequate (Report published 28 May 2019)

Why we inspected: This location was rated as Inadequate following inspection in October 2018 and was placed in special measures. We urgently imposed conditions on the providers registration which meant they could not admit anyone into the home and which required them to undertaken certain governance processes and report to us monthly. This was a planned inspection to follow up on the previous rating of inadequate and check improvements had been made.

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

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Edenvale Nursing Home 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.

Edenvale Nursing Home provides accommodation and personal care for up to 35 older people some of whom may be living with dementia. There were 29 people living at the home at the time of this inspection. Accommodation at the home is provided over three floors. There are large gardens and patio area’s which provide a safe and secure private leisure area for people living at the home.

There was 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 and associated Regulations about how the service is run.

Relevant recruitment checks were conducted before staff started working at Edenvale Nursing Home to make sure they were of good character and had the necessary skills. However, there were unexplained gaps in staff employment histories.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were taken in the best interests of people. However, we had not been informed where people had a Deprivation of Liberty safeguarding authorisation in place.

People and their families expressed the view staffing levels needed to be improved especially at weekends. The registered manager and provider were actively recruiting to fill a staff vacancy for a cleaner at the weekend.

People told us they liked the food. People received varied meals including a choice of fresh food and drinks. People were supported and encouraged to make choices and had access to a range of activities.

People felt safe living at Edenvale Nursing Home and risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies.

Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. People were supported to take their medicines safely from suitably trained staff. Staff were aware of people’s likes and dislikes and went out of their way to provide people with what they wanted.

Staff received support and one to one sessions or supervision to discuss areas of development. They completed a range of training and felt it supported them in their job role. New staff completed an induction programme before being permitted to work unsupervised.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

The registered manager maintained a high level of communication with people through a range of surveys and meetings. ‘Residents meetings’ and surveys allowed people and their families to provide feedback, which was used to improve the service. People felt listened to and a complaints procedure was in place.

There were appropriate management arrangements in place. Regular audits of the service were carried out to assess and monitor the quality of the service.

Edenvale Nursing Home is registered to provide care for up to 35 people. The home is registered with the Care Quality Commission to provide nursing or personal care for older people, physical disability, mental health conditions or people living with a dementia. At the time of our inspection there were 34 people in receipt of care from the provider. The home consisted of two units spread over three floors. The first floor had 10 beds commissioned by the clinical commissioning group as a step up and step down unit. People were admitted to these beds from their home or hospital to enable a period of re-enablement. This reduced the need for people to be admitted to hospital or remain in hospital longer than required.

The home had a manager in place who was in the process of applying to become the 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.

People using the service we spoke with told us they felt safe in the home and staff were aware of the procedure to take if abuse was suspected.

Staff were recruited safely and records included appropriate checks on them as well as proof of identity to ensure they were appropriate for the role they were employed to undertake.

Medicines were stored and secured appropriately. People told us that they received their medicines on time.

The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). When people were assessed as unable to make decisions for themselves the MCA process had been followed. DoLS are put in place to protect people where their freedom of movement is restricted to prevent them from possible harm. The registered manager had taken appropriate action for people who needed their movement restricted.

People had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.

People were looked after by kind and caring staff who knew them well. They were supported to express their views and to be involved in all aspects of their care. People were treated with dignity and respect.

There were a number of quality audits in place to assist the provider in assessing and reviewing the delivery of care in the home. The manager who had recently commenced at the home had identified several areas of improvement that would improve the quality of the service provided. The manager had developed an action plan to address these and set completion dates for each area.

Care was provided over three floors and all rooms were en suite and single occupancy. The home also provided a short term support facility for people who had recently been in hospital or were admitted from the community requiring additional support to maintain their independence. This was in conjunction with the NHS.

People were able to personalise their rooms with their own possessions and could access their rooms whenever they chose. Many people chose to remain in their rooms throughout the day, however there were three communal lounge or dining areas available for people to use.

We saw that person-centred care plans were in place to support people and staff had a good awareness of people's needs. People had their care discussed and agreed with them or their representative. Where people were unable to consent to the care they required we saw that the provider had acted in accordance with the legal requirements.

Staff treated people in a kind and gentle manner respecting their dignity at all times.

People we spoke with told us they were happy living at this home. One person said, 'The staff are wonderful, they look after me beautifully and I love them all.'

They told us if they had any concerns or wished to raise a complaint they would tell the manager. One person said that that the staff treated them well and were always available to help them with their care.

Visitors we spoke with made us aware they were happy with the care their relatives received. One visitor told us: "This is a beautiful place they really look after my wife and keep me informed with her care'.

We saw that people's privacy and independence were respected. People experienced care based on detailed care plans and risk assessments that documented people's preferences and met individual needs. We also saw examples of records and delivery of care where improvements were required.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding.

There were sufficient numbers of staff. Records showed that staff had received ongoing training and supervision; however, we saw that the frequency of supervision to ensure consistency could be improved.

The Provider had effective systems in place to monitor quality assurance and compliance.