Archived: Edwardian Care Home

The service provides care and support to people with a range of support needs, including chronic health conditions, physical disabilities, mental health needs, learning disabilities and those living with dementia. At the time of the inspection, 26 people were being supported by the service.

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.

The provider had effective systems in place and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. People’s medicines had been managed safely and administered in a timely manner.

The provider had effective recruitment processes in place and there was sufficient staff to support people safely. The manager and staff understood their roles and responsibilities in ensuring that people’s care was provided in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff had received effective training, support and supervision that enabled them to provide appropriate care to people who used the service.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences and choices. They were supported to have sufficient food and drinks, and had access to other health and social care services when required in order to maintain their health and wellbeing.

Staff were kind and caring towards people they supported. They treated people with respect and supported them to maintain their independence as much as possible. Some activities had been provided to occupy people within the home and people had been given opportunities to pursue their varied hobbies and interests outside of the home.

The provider had a formal process for handling complaints and they responded quickly to people’s concerns. They encouraged feedback from people and their relative, and acted on the comments received to improve the quality of the service provided.

The manager provided stable leadership and effective support to the staff. They worked closely with the deputy manager to ensure that the provider’s quality monitoring processes are used effectively to drive improvements.

One inspector from the Care Quality Commission (CQC) conducted this inspection. We gathered evidence against the standard we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? Below is a summary of what we found.

Is the service safe?

People's needs had been assessed and risk assessments described how any identified risks to people were minimised. We saw that the premises were clean and hygienic. The manager had ensured that the care provided to people who used the service met the requirements of the Mental Capacity Act 2005, and the related Deprivation of Liberty Safeguards. People were supported by staff who were appropriately trained and had regular supervision to enable them to provide safe and appropriate care.

Is the service effective?

Detailed care plans were in place to provide guidance to staff on how to deliver appropriate and effective care. We also saw evidence that the provider sought additional support from other health and social care professionals, to ensure positive care outcomes for people who used the service.

Is the service caring?

We observed that people were supported by kind and attentive staff. From our observations and from speaking with the staff, we noted that they had a good understanding of the needs of the people they supported. The people we saw also appeared happy and well looked after.

Is the service responsive to people's needs?

We saw that the care plans had been updated when people's needs had changed, and that referrals had been made to other health and social care professionals when required. The service took account of individual preferences, and people were supported to engage in a variety of activities of their choice. The service was responsive to people's concerns and complaints, and acted promptly to resolve these to the complainants' satisfaction.

Is the service well-led?

The service had a registered manager in post, who had transferred from one of the provider's other care homes in June 2014. We found the provider had made significant improvements to the quality of the care provided to people who used the service and the environment in which care was provided. The manager had put systems in place to ensure that they had robust processes to regularly assess and monitor the quality of the service. They also ensured that records were well maintained and updated when necessary.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, the staff who supported them and looking at records.

Is the service caring?

We spoke with three of the 18 people who lived at the home on the day of our inspection. They told us that they were happy with the care that they received. One person told us, "It is like any ordinary home. I'm happy here. I have no reason to be anything else."

Is the service responsive?

We saw that the manager had referred one person to the Community Adult Nursing Service when they had developed a blister on one of their heels. This showed that the manager obtained professional assistance when this was required.

People were not made aware of the complaints system. We saw that the home had a complaints policy. This was available to people who visited the home in a folder in the entrance hall. However, people who lived at the home were unable to access this as the door from the home to the entrance hall was kept locked at all times. We spoke with three people who used the service. They did not know that there was a complaints policy for the home. Two people did not know how to make a complaint.

We looked at the complaints record. This showed that no complaint had been received since 2012. However, one person told us that they had complained that some of their clothing had gone missing three weeks earlier. This complaint had not been recorded.

Is the service safe?

We looked at some comment cards that had been completed by visitors to the home. One comment was, "My [relative] is safe and this gives me peace of mind. The staff are committed to their job."

People's needs were assessed and care was planned in line with their individual care plan. We looked at the care records of five people who used the service. We found that these were personalised and detailed. We found that care had not been delivered in accordance with people's care plans. The care plan for dietary requirements for people who lived in the home identified that their weight should be monitored on a monthly basis. We found that people's weight had not been recorded since January 2014.

On the day of our inspection the home was free of any bad odours. The manager showed us around the building and we looked in a random selection of people's rooms, the communal areas including toilets, bathrooms and the kitchen. The manager told us that the home had been rated as a level four of five [good] by the local environmental officer for food hygiene. However, they were unable to evidence this as the relevant document could not be located. During our tour of the building we found several areas in which the standard of cleanliness was not met.

The manager confirmed that they had identified gaps in staff member's essential training and had taken steps to address this.

During the course of our inspection we identified that records that related to the management of the home were not readily accessible. The manager told us that they had been unable to locate essential certificates that related to safety at the home, such as checks of the gas and electrical systems.

Is the service effective?

We looked at the care records of five people who used the service. We found that these were personalised and detailed. Each contained a history of the person, information on their likes and dislikes and their personal preferences around times they got up, meal times and the time they preferred to go to bed. There were care plans that covered all aspects of people's lives.

The majority of people who lived in the home were living with some degree of dementia. However, only one of the care records we looked at had an assessment of people's capacity to make decisions about their care needs included. Where people did not have capacity to make decisions about their care, or had a lawful representative to make decisions on their behalf, we found that there were no best interest discussions recorded. The provider had therefore failed to act in accordance with legal requirements.

We saw that the provider had a policy for supervision and appraisal for staff members. This stated that a staff member should have five supervision meetings and one appraisal meeting a year with their manager. However, we identified that the policy had not been followed.

Is the service well led?

The manager had been in post for two weeks at the time of our inspection. They were an experienced manager who had transferred from another home within the provider's organisation.

We saw that the area manager completed monthly audits of the quality of service provided on behalf of the provider. The area manager showed us the results of the most recent audit, completed in May 2014. This audit had identified many of the shortfalls, particularly in the environment, that we noted during our inspection. We saw that an action plan had been developed by the area manager following this audit. However, none of the actions identified in the plan had yet been completed.

We imposed compliance actions with regards to both areas and told the provider they needed to make improvements in this area.

The provider submitted an action plan, which stated that a full and extensive audit had been completed of all staff files. It confirmed that all staff files now contained all the information specified in Schedule 3 of the Health and Social Care Act 2008. They told us they had implemented a training matrix and staff would be undertaking mandatory and specialists training, such as medication administration and dementia care. On 24 July 2013 we carried out an unannounced inspection to check that these actions had been implemented.

We found appropriate arrangements in place in relation to the management of medicines. However, during our inspection we found that recruitment processes required action as there were some gaps and inconsistencies identified in these records. We also found issues with regards to staffing levels in the home and staff requiring additional training to meet people's specific needs.

Our visit spanned the lunch period and we witnessed a relaxed atmosphere in the home. The staff were friendly and polite in their approach to people and offered appropriate support. Throughout, people were asked to make choices about what they ate and drank and when one person chose not to eat the meal they had ordered a number of alternatives were offered to encourage them to eat and gain some nutrition.