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Inspection carried out on 8 February 2018

During a routine inspection

This inspection took place on 8 February 2018 and was unannounced. This meant the provider and staff did not know we would be visiting.

The Edwardian is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Edwardian accommodated nine people at the time of the inspection.

The service was last inspected on December 2015 and the rating for this inspection was Good. At this inspection we found the service remained Good.

People's care records contained clear and easy to understand information about people's needs and risks and how to support them effectively. For those people who were not always able to express their needs and wishes verbally or when a person had declining mental health, staff had detailed information about the behaviours, gestures and body language people would display to communicate their needs or emotions. This was good practice and enabled staff to connect with the people they were supporting.

People received their medicine safely and were supported to access the support of health care professionals when needed. The provider had taken steps to minimise the risk of abuse because staff knew how to identify and report it.

There were enough staff to meet people's needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff told us they received training to be able to carry out their role. Staff received effective supervision and a yearly appraisal.

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.

People received a varied and nutritional diet and were complimentary of the food provided.

The interactions between people and staff showed that staff knew the people really well. Staff spoken with had a good knowledge of people's needs and spoke with genuine affection about the people they supported. The atmosphere at the home was homely, relaxed and nurturing. It was clear that people felt relaxed and comfortable in the company of staff.

The management team were approachable and they and the staff team worked in collaboration with external agencies to provide good outcomes for people. Processes were in place to assess and monitor the quality of the service provided and drive improvement.

Further information is in the detailed findings below.

Inspection carried out on 3 December 2015

During a routine inspection

The inspection visit took place on the 3 December 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We last inspected the service on the 15 February 2015 which was a follow up inspection from April 2014. In April 2014 we found that the service needed to improve its quality assurance systems. In February 2015 we saw this had been completed and the service was not in breach of any regulations at that time.

Edwardian is a care home that provides accommodation for up to eleven people who have mental health needs. It is located close to Stockton town centre.

There is 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.

All people we spoke with told us they felt safe at the service. Staff were aware of procedures to follow if they observed any concerns.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager and staff had the appropriate knowledge to know how to apply the MCA and when an application should be made and how to submit one. This meant people were safeguarded.

We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of people who used the service such as mental health and management. There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the management and of each other. Medicines were also stored and administered in a safe manner.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development.

We saw people’s care plans were person centred and had been well assessed. The home had developed care plans to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home, from planning entertainment to helping to make the evening meal.

Staff had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. We saw how people were involved in planning all the meals at Edwardian.

We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members. There was a warm and caring atmosphere in the service and people were very relaxed. We saw people were treated with dignity and respect. Relatives and people told us that staff were kind and professional.

We also saw a regular programme of staff meetings where issues where shared and raised. The service had an easy read complaints procedure and staff told us how they could recognise if someone was unhappy. We joined in the regular residents meeting where we saw people being involved in lots of aspects of how the service was delivered. This showed the service listened to the views of people.

Any accidents and incidents were monitored by the registered manager to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Edwardian.  Action plans and lessons learnt were part of their ongoing quality review of the service

Inspection carried out on 15 February 2015

During an inspection to make sure that the improvements required had been made

One inspector carried out this follow-up inspection. At the time of our inspection 11 people lived at Edwardian.

We carried out this inspection to check that improvements had been made in respect of shortfalls in the quality checking systems identified on our previous visit on 01 April 2014.

During our inspection on 15 February 2015, we spent time speaking with the registered manager and two care staff. We also spoke with three people and spent time observing people and staff. We looked at records that related to quality checking systems, two care plans, medication documentation and records relating to meetings and feedback. We found that improvements had been made and that there was a robust system in place to ensure that people were protected from risks to their health, safety and welfare. If you want to see the evidence that supports our summary please read the full report.

Inspection carried out on 1 April 2014

During a routine inspection

Are services safe?

Care plans and risk assessments were in place and were updated as people’s needs changed. Records detailed the support people required and encouraged people to be independent where possible.

People had been cared for in an environment that was safe, clean and hygienic. People’s own rooms were individualised.

The Edwardian did not use a formal dependency tool to assess staffing levels, however the manager told us that the same staffing levels had been in place for many years. They told us that staffing had been increased when needed, such as when outings where planned or when people’s needs increased. During our inspection we saw there were enough staff on duty to meet the needs of people living at the home.

All seven people we spoke with told us that they felt safe living at the Edwardian.

Are services effective?

People told us they were happy with the care that had been delivered and had their needs met. It was clear from our observations and from speaking with staff that they had a good understanding of people’s care and support needs and that they all knew them well. One person told us, "I am looked after very well here.”

The records which we looked at showed that some people were not able to make complex decisions for themselves but we did not find any evidence of a Mental Capacity Assessment. CQC monitors the operation of the Deprivation of Liberties safeguards which applies to care homes. While no applications have been submitted, policies were in place. We looked at training records for Deprivation of Liberties and Mental Capacity Assessment and found that only the manager has received training. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Are services caring?

People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this.

Staff we spoke with were very passionate about their work and were proud of what they did. Staff were committed to the people they cared for and the values of the organisation.

Are services responsive to people’s needs?

People’s needs had been assessed before they moved into the home. Care plans were detailed and included information on people’s likes, dislikes and daily routines which helped to determine how and when support was given. One person told us, “The staff looked after me very well when I had my fall, they are very good. I feel much safer here.”

People had access to activities both within the home and out in the local community. This was important to them and hey had been supported to maintain relationships with their friends and relatives.

Health professionals were involved in people’s care as needed. We saw that people were supported to attend appointments.

Are services well-led?

We saw that people completed a customer satisfaction survey twice per year. We saw that staff and resident meetings were carried out regularly and all people we spoke with confirmed they had been listened to. Both staff and people we spoke with said they felt very well supported and they could raise any concerns. Staff we spoke with told us they enjoyed working for the organisation and had worked for the company for many years.

The manager told us that the home was continually refurbished and people were given choice about how their rooms were decorated.

Internal audits help to monitor the quality of the service and the health and safety of people and their environment. However we found that only one audit was carried out regularly. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Inspection carried out on 23 April 2013

During a routine inspection

We spoke with two people who used the service. They told us they were treated well, the staff were nice and they had no complaints. One person said, “The staff are brilliant, if you want something you just have to ask.” Another person told us, “I am treated very well, I am better off here than at home.”

We observed staff interacting well with people and saw there was a friendly and relaxed atmosphere between people living and working at the home. We found that people were encouraged to be independent. One person told us, “Today I went out for fish and chips” and “I am going out for a coffee with my brother this evening.” This contributed to maintaining people's welfare and promoting their wellbeing.

We saw that people who used the service had a choice of food and drink and regularly discussed menu options at ‘residents’ meetings. One person told us, “We get a choice of food, if you don’t want something you just ask and they sort something out.” We found that there was a choice of suitable and nutritious food and hydration to meet the needs of people who used the service.

We found that people were supported by suitably qualified, skilled and experienced staff.

We found there was an effective complaints system in place at the home.

Inspection carried out on 30 May 2012

During an inspection to make sure that the improvements required had been made

The visit took place because we were following up concerns raised at an inspection

in December 2011. During the visit, we spoke with six people who used the service, as this was a routine visit we asked people about the choices on offer; what the care was like; and what people thought about the staff. People expressed satisfaction with the care and service that they received. People told us that they felt the staff really worked hard to make the home run well and always tried to assist them get the best out of their lives. Comments made by people who used the service included:

“I like living here, staff are friendly and all of them are nice.”

“I have a choice what food is cooked and provided at mealtimes.”

“I go to the town during the day and have a bet.”

“I go to college once a week to do english and once a week to do maths.”

“I go out with my brother tonight and on a Wednesday.”

People told us that the service was run well and that the manager who also owned the home made sure everything operated smoothly. People told us that they felt that all the staff were competent and supportive. People said ‘’The staff help me to deal with my worries’’, ‘’The staff really care’’ and ‘’The staff sit down with me and go through my plans to see how what needs to be done’’.

Inspection carried out on 2 December 2011

During a routine inspection

During our visit we spoke with seven people who used the service. People who used the service expressed satisfaction with the care and service that they received.

One person said "This is my home. I like living here". Another person said "We get on very well with each other. It is like a family".

Another person said "Staff are so nice and there is a good group of residents".