Archived: Edgeley House Care Home

Edgeley House Care Home is a residential service providing support with personal care or nursing needs for older people. The service can accommodate up to 60 people although, at the time of the inspection there were 27 people living there, including people living with dementia.

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

The provider had assessed the risks associated with people’s care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm to people.

The provider had systems in place to respond to incidents, accidents or other issues of concern raised with them.

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 17 March 2020).

Why we inspected

The inspection was prompted by notification of a specific incident, following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of safety. We undertook this targeted inspection to examine those risks.

We use targeted inspections to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

The overall rating for the service has not changed following this targeted inspection and remains good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Edgeley House Care Home on our website at www.cqc.org.uk.

Edgeley House is a residential service providing support with personal care or nursing needs for older people. The service can accommodate up to 60 people although at the time of the inspection there were 43 people living there including people living with dementia. The home is an adapted two storey building.

Peoples experience of using the service:

People were cared for by staff in a way that kept them safe and protected them from avoidable harm. People were supported by enough staff who were available to respond to their needs in a timely manner. People received their medicines when they needed them, and systems were in place to ensure medicines were stored and administered safely and adequate supplies were available. Accidents and Incidents were investigated, and measures were taken to prevent re-occurrences. The premises were clean, and staff knew and followed infection control principles.

We saw positive feedback about the quality of care. The feedback on the leadership of the service and the registered manager from people and staff was positive. There were effective governance systems in place to monitor the quality of service and the health, safety and welfare of people.

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 July 2019)

Why we inspected

We had received concerns in relation to staffing and the culture of work at Edgeley House. As a result, we undertook a focused inspection to review the Key Questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Edgeley House is a care home in its own grounds registered to provide nursing and personal care for up to 60 people. It is located in the north Shropshire town of Whitchurch.

People’s experience of using this service:

People told us the registered manager and staff were kind, friendly and caring and they felt safe.

There had been a change of registered manager since we last inspected. People were positive about the way the registered manager ran the home and the changes they had made.

People were safe and protected from abuse because staff assessed and managed risk. People were supported by staff who had been recruited safely, appropriately trained and supported. There were enough staff to support people and they had the skills, knowledge and experience needed to provide good care. People received their medicines as they needed. The home was clean and maintained and staff practised good infection control. The home and equipment had been maintained.

Staff supported people to eat healthy nutritious food and drink sufficient fluids and knew their likes and needs. They helped people to attend healthcare appointments to assist their health and wellbeing. The design of the home met people’s needs. There were dementia friendly signs and equipment to help with orientation, daily living and socialisation. People were helped 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. Staff assessed people's capacity to make decisions and supported them with decision making.

People were supported in a considerate and caring way and treated with dignity and respect. They received care that met their diverse needs and preferences. Staff involved people in planning their care and encouraged them to make choices.

Care was personalised and met people’s needs and preferences. People followed activities they enjoyed. They were supported to air any concerns and the registered manager took action on these. Staff understood the importance of supporting people to have a comfortable, pain free and peaceful end of life. Their end of life wishes were recorded so staff were fully aware of these.

The registered manager, provided good leadership and motivated the staff team. People said they were asked for their views and these were taken into account. They were praising of the registered manager and staff team. The management team used a variety of methods to check the quality of the service and develop good practice. They worked in partnership with other organisations to make sure they followed good practice and people in their care were safe.

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

Rating at last inspection:

At the last inspection the service was rated good (published 25 August 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We may inspect sooner if any issues or concerns are identified.

Edgeley House provides personal and nursing care for up to 60 people. At this inspection 30 people were living there some of whom were living with dementia.

A manager was in post and present during our inspection. The manager was newly appointed and commenced work at Edgeley House approximately eight weeks prior to this inspection. We confirmed that they had submitted appropriate applications 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.

At the last inspection on 16 and 17 December 2015, we identified four areas where the provider was not meeting the requirements of the law. The registered provider did not have an effective quality assurance monitoring system in place to ensure people received a safe and effective service. People were not involved the planning of their own care and were not treated with dignity and respect. There were not enough staff to make sure people’s needs were met and they were supported with their hobbies and interests.

The provider sent us an action plan in April 2016 telling us what they would do to make improvements and meet legal requirements in relation to the law. We found at this inspection the provider had taken the necessary measures to ensure the quality of care people experienced had improved.

People were involved in decisions about their day to day care and people had care plans which were mostly individual to them. Care plans contained personal likes, dislikes and personal histories and were either recently reviewed or in the process of being reviewed. Staff had a good knowledge of the people they supported. People and staff had positive relationships. People took part in activities they liked and found stimulating.

When people could not make decisions for themselves staff understood the steps they needed to follow to ensure their rights were upheld. People were involved in the day to day running of their home and attended regular resident meetings.

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. Risks associated with people’s care had been assessed and actions put in place to minimise the risk of harm.

There were enough staff to support people and to meet their needs. The provider had systems in place to adapt to the changing needs of people and to make provision for additional staffing when required. Before staff could start work the provider undertook checks to ensure they were safe to work with people.

People received their medicine from staff who were trained to safely administer these and who made sure they had their medicine when they needed it. The provider undertook checks to ensure staff followed safe practices when helping people with their medicines.

Staff had the skills and knowledge to meet people’s needs. Staff attended training that was relevant to the people they supported. Staff were supported by the provider and the manager who promoted an open and transparent culture.

Staff made sure people were involved in their own day to day care and information was given to them in a way people could understand. People’s independence was encouraged and staff respected their privacy and dignity.

People had a choice of food to eat and were prompted to maintain a healthy balanced diet. People’s routine health needs were looked after and people had access to healthcare when they needed it.

People and staff felt able to express their views and felt their opinions mattered. The provider and manager undertook regular quality checks in order to drive improvements. The provider engaged people and their families and encouraged feedback. People felt confident they were listened to and their views were valued.

We judged that the provider had made significant improvements to improve the quality of treatment and care to people who use the service. This evidence supported our judgement to improve the

rating to ‘Good’ overall during this inspection.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

In this report the name Gillian Ann Bratt appears, who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still identified as the registered manager on our register at the time.

This is a summary of what we found:

Is the service safe?

We had received concerns from the Clinical Commissioning Group (CCG) about the lack of wash areas to meet people's needs. On the day of our inspection the nurse in charge confirmed one shower room was available for 36 people. This meant there were insufficient wash areas available for people to access. The CCG also raised concerns about the cleanliness and hygiene standards within the home. We found that some areas of the home were unclean but this was also compromised by refurbishment taking place on the day of our inspection.

We saw that a number of people required the use of a wheelchair. We observed that foot plates were either missing or not used. We observed a care staff manoeuvring a wheelchair without foot plates and saw that the person's feet remained in the same position whilst the wheelchair was turned. This placed the person at risk of discomfort and injury.

Discussions with the acting manager confirmed that a number of overseas nurses had been appointed and their first language was not English. We heard two nurses not speaking in English. One person who used the service told us, 'I find this very frustrating.' The fire safety officer raised concerns that one staff member had very little understanding of the home's evacuation procedure because of their poor understanding of the English language. This meant that people who used the service may not be able to communicate with all the staff effectively and this could compromise their wellbeing and safety.

On the day of the inspection a major refurbishment of the premises was taking place. Whilst walking around the home we saw a number of items that obstructed the corridors. This had an impact on the evacuation process in the event of a fire and was also a trip hazard.

During the inspection we saw that a number of fire doors were wedged open with furnishings. These practices could also compromise people's safety in the event of a fire. We shared these concerns with the fire and rescue department who have carried out their own inspection of the premises.

Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted policies and procedures were in place. The area manager said that this would be kept under review.

Is the service effective?

One person who used the service said, 'It depends on what cook is on duty to the variety of foods available.' Another person told us, 'The food is very good.' Discussions with people who used the service, staff and the records we looked at confirmed that people's nutritional needs were met.

Some people required assistance with eating and drinking. We saw that one person was not assisted with their meal in a dignified manner. However, we also observed some good practices. For example, staff sat with a person and assisted them in a kind and gentle manner.

Records were in place to monitor people's body weight and where necessary referrals were made to a dietician or speech and language therapist (SALT) to provide additional support.

Is the service caring?

One person who used the service told us, 'The staff do look after me, they do their best.' Another person said, 'Its good living here.' We found that the environment was unsuitable to ensure people's privacy. For example we saw that a number of toilet doors were not fitted with a privacy lock and this was acknowledged by the acting manager. One person who used the service said, 'I call them the second class toilets and I don't use them. I go to the other side of the home where the toilets have a lock.' The absence of privacy locks meant that people's privacy would not be entirely maintained.

We saw a number of people were left in their wheelchairs at meal times and one person was asleep in their wheelchair. This could compromise people's comfort and safety. The acting manager acknowledged that this practice was unacceptable and said that people should be transferred into suitable seating.

Is the service responsive?

One person who used the service told us that they had written a letter of complaint to the area manager. They confirmed that the area manager had visited them to discuss their complaint but this had not been responded to in writing They said that no action had been taken to resolve their complaint. The area manager said because they had discussed the complaint with the person they did not respond in writing. This meant that people could not be confident that their complaints would be addressed appropriately.

Is the service well-led?

The registered manager had recently resigned. A new acting manager had been appointed and on the day of the inspection the acting manager had been in post for two weeks. The acting manager was aware of some of the shortfalls we had identified and was in the process of developing an action plan to address these.

The people we spoke with told us that they were impressed that the acting manager had made the effort to introduce them self. Two people showed us a letter that they had received from the acting manager inviting them to a meeting.

Audits were in place to monitor accidents and incidents to establish trends. This enabled the provider to take the appropriate action to reduce further reoccurrence to ensure people's welfare.

The acting manager said that an audit was in place for the management of medicines and we saw this This ensured that people received their prescribed treatment.

People who lived in the home told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff talked of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were mostly available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'The staff are very good' and another said, 'The staff are lovely'.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, 'Very helpful staff' and another said, 'The staff are very good'.

The provider had developed a system whereby they could monitor how well the home was meeting the needs of the people who live there.

We saw maintenance, repair and improvement work being carried out in communal and private areas within the home. This involved such things as new flooring, decorating and installing new doors in the corridors.