Archived: Edwina House Nursing Home

Updated 30 December 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10 November 2015 and was unannounced.

The inspection team comprised of one inspector and a specialist advisor who is a practising nurse in dementia care.

Before the inspection we reviewed information we had about the provider including notifications and incidents affecting the safety and well-being of people using the service. We also contacted the local authority safeguarding team for their views about the home.

During the visit we spoke with eight people who used the service, two relatives, 11 staff members including the registered manager and co-director. We also spoke to the community matron from Care Home Assessment Team (CHAT). Some people could not tell us about what they thought about the home as they were unable to communicate with us verbally therefore we spent time observing interactions between people and the staff who were supporting them.

We looked at the care records of six people who used the services and checked files and records of nine care staff members. Other documents checked relating to people’s care included risk assessments, medicine records, staff and residents meetings minutes as well as health and safety documents, policies and procedures.

Updated 30 December 2015

We inspected the service on 10 November 2015. The inspection was unannounced.

Edwina House Nursing Home provides accommodation for up to 22 people who require nursing and personal care. The service supports people living with mental health conditions, physical disabilities and dementia. The home has two levels. There are two lounges inclusive of dining areas, the main kitchen and bedrooms on the ground floor and further bedrooms situated on the first floor. There is a lift for access to the first floor. On the day of our inspection 16 people were using the service.

At the time of our inspection 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.

People we spoke with were positive about the care that they received and the staff that supported them. We saw people being treated with kindness and respect. Staff were aware of people’s individual needs and how they were to meet those needs. Staff were also aware of people’s likes and dislikes and knew what they needed to ensure that people were happy.

There were a number of systems in place in order to monitor and maintain people’s safety. However, these were not always being followed. We looked at eight staff files out of which we could only evidence that criminal record checks had been carried out for five staff members. Some of the criminal record checks also dated back to 2003 and there was no evidence that these had been reviewed or updated. Therefore, the service would not be aware of any convictions the staff member may have received since the date of the check to the present day. This could place people at risk whereby the service may be employing a staff member who possibly may not be permitted to working with vulnerable adults.

Most staff had the appropriate knowledge and skills necessary to support people who used the service. There was inconsistency in the training that was provided and some staff had not received training in areas such as safeguarding, infection control and in specialist areas such as managing a catheter and pressure care. However, staff we spoke with confirmed their understanding of abuse and the actions they would need to take if they witnessed any type of abuse. People told us that they felt safe living at the service and that staff treated them with dignity and respect. People felt listened to and said that staff respected their choices and decisions.

We looked at care plans and found them to be detailed and person centred. Risks had been identified and appropriate risk assessments had been put in place and were reviewed regularly. As part of the review process it was positive to note that medicine reviews had taken place for all residents in conjunction with the GP and the Care Home Assessment Team (CHAT). However, for some people who were supported in bed, staff were unaware that a re-positioning chart needed to be completed to record when a person was turned in order to prevent pressure sores. The service had not put a form in place and had not advised staff about the completion of this.

There were some aspects of medicine management that were not safe. We found that the service did not follow safe processes when administering medicines. Medicines were administered from the medicine room, on the first floor, into medicine pots and then taken round to people without any method of identifying whose medicine was in which pot. The nurse administering medicines was also not using the Medication Administration Record (MAR) to correspond which medication she was administering for each person. We also noted where people were administered medicines covertly, appropriate procedures had not been followed in relation to completing a Mental Capacity Assessment (MCA) and best interest decision had not been recorded.

The registered manager and some staff members had a good understanding of the Mental Capacity Act 2005 and were able to demonstrate a good knowledge base on how to obtain consent. However, most staff had not received any formal training in this area and were unaware of what a Deprivation of Liberty Safeguard (DoLS) was and how this should be applied. The service had not implemented the principles of the Mental capacity Act 2005 (MCA) especially where Deprivation of Liberty Safeguards (DoLS) were applicable. DoLS authorisations are required to be in place to ensure that where an individual is being deprived of their liberty that this is done in their best interest and in the least restrictive way.

We found the home to be clean, however, there was an unpleasant odour around the home throughout the whole day. Concerns were also noted about the management of heavily soiled items of clothing and how the service ensured that these were washed at the recommended temperature to prevent cross-contamination. The registered manager told us that on occasions staff would wash heavily soiled items in a sink by hand before taking them to the laundry.

There was a maintenance log, equipment maintenance records and fire alarm checks that the service was undertaking on a regular basis. However, the service did not complete any quality assurance audits in order to identify issues or concerns with the running of the service in order to ensure any potential risks are eliminated and to resolve any issues or concerns highlighted by the audit.

People told us that they enjoyed the food that was prepared and enjoyed their meals. The chef was aware of people’s likes and dislikes and also of anyone with a special diet. One relative commented about the food and told us “my relative is eating quite well and has put on weight since he has been at the home.”

People confirmed they knew who the manager was and also knew who the directors of the service were. People felt confident that they could raise issues or concerns with the management and relatives also felt that the management was approachable. We also spoke to health care professionals who were working with the home who told us that they had no concerns with the quality of care provided.

Staff were positive about working at the home and told us that they felt supported in carrying out their role. We saw that supervisions were undertaken for staff members but these were not consistent and were not in line with the services supervision policy. The service had also not completed an annual appraisal for most staff members employed by the service.

We saw some positive interactions between staff members and people living at the service. An activity plan was on display stating that activities would take place between 3pm and 4pm. We did not observe any activities taking place throughout the day and people told us that there were not enough activities offered at the home.

We have made a number of recommendations in relation to the service’s policies and procedures, analysis of accidents and incidents, improved signage around the home, infection control, safe recruitment checks and activities.

We also found six 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 the report.