Archived: St Edwards Rehabilitation Home

Updated 13 June 2016

St. Edwards Rehabilitation Home is a service providing 24 hour support and accommodation for male or female adults between the ages of 18-65, who have been previously using mental health services, in order to promote independent living. It has accommodation for up to five patients.

St. Edwards undertakes the following activities that are regulated by the Care Quality Commission: treatment of disease, disorder or injury.

The service registered with the CQC on 6 June 2013. The CQC has not previously inspected this service. The provider was also the manager in day to day charge of the service.

Updated 13 June 2016

We decided to cancel the registration of this service because of the evidence we found on inspection. This means the provider will no longer be able to operate the service at this location.

We rated St. Edwards as Inadequate because:

• The provider failed to maintain a clean and safe environment. The building was in a very poor condition throughout. It had an unpleasant smell and the main lounge was damp. A number of the rooms and the walls and floors throughout were dirty. The garden fence that separated the building from a neighbouring, occupied property was broken in many places. This put the safety of patients at risk and undermined their privacy and dignity.

• The provider had failed to assess or mitigate risks to patients. They had not assessed the risk posed by potential ligature points and had no evacuation plan in the event of fire for the patient at the location. The provider had not assessed the risk of or acted to prevent infections. There was no audit of infection control measures and no soap in the patient’s bathroom.

• The provider did not undertake proper risk assessments and did not update risk assessments following incidents to ensure the safety of patients. The provider also did not properly record serious incidents, or record any investigations into incidents when they occurred or the actions the provider intended to take to reduce future incidents.

• The provider had not made all necessary, reasonable adjustments to ensure that a disabled patient could access all parts of the service without difficulty. This was in breach of their duty to make such adjustments under the Equality Act 2010.

• The unit was inadequately staffed. The sole patient at the service at the time of our visit was frequently left alone in the building. Not all staff at the location had the necessary skills, training and experience to undertake their duties; including a volunteer cleaner who was sometimes left in sole care of a patient. The service did not check references for new staff or do background checks on employment history or character. The provider had not undertaken a police check on the volunteer cleaner. The provider did not undertake any formal supervision of staff.

• The provider did not manage medicines according to policy or national guidance. Staff stored dugs in places that were unsuitable to keep them secure and did not properly record the administration of drugs to demonstrate that they had done so safely.
• The provider did not properly monitor the physical health of the patient or produce care plans to address their physical healthcare needs. The staff failed to provide suitable and nutritious food to support the patient’s health. The care planning undertaken by staff contained little information that reflected the patient’s wishes or preferences and staff did not update care plans in response to incidents. Staff did not regularly update their daily observations of the patient, or record the details of any meetings they had with other professionals to discuss the patient’s care and treatment.

• The provider failed to employ proper systems to ensure that they could monitor the quality and safety of the service. The provider either had incomplete audits of the service or had failed to undertake them.

• The provider did not have in place proper systems either to record or to respond to complaints raised by the patient concerning their care and treatment.

Updated 13 June 2016