Archived: Edinburgh House

Updated 16 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was undertaken at this time as the last inspection was rated overall requires improvement. 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.

Prior to the inspection we had received concerns about staffing and a high use of agency, food and the safety of equipment. We looked at these areas as part of our inspection.

This inspection took place on 23 and 25 July2018 and was unannounced.

The inspection team consisted of one inspector and an expert by experience who had experience in caring for older persons. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission. A notification is information about important events which the service is required to tell us about by law. Prior to the inspection we reviewed information included on the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used this information to help us decide what areas to focus on during our inspection.

Not all people living at Edinburgh House were able to verbally express their views about the service. Therefore, we spent time observing interactions between staff and people within the communal areas of the home. We spoke with two people who lived at home and four relatives. We also spoke with the registered manager, the nominated individual for the provider, two senior managers and a visiting professional. We spoke with 13 staff, including care staff, ancillary staff, activity staff and agency workers.

We looked at the care plans and associated records of six people, medicines administration records for 14 people, staff duty rotas, four staff recruitment records and eight staff supervision records. We looked at staff training records, records of complaints, accidents and incidents, policies and procedures, safeguarding and quality assurance records.

Updated 16 August 2018

This inspection took place on 23 and 25 July 2018 and was unannounced. At our last inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There had been a failure to ensure staff were trained and supported and a failure to ensure a robust process to identify and make improvements. At this inspection we found improvements had been made and there was no longer a breach. However, further work was needed to make the improvements to records and systems which enabled learning. This was being undertaken at the time of our inspection.

Edinburgh House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Edinburgh House can accommodate up to 32 older people in one adapted building. The home has two floors accessed via stairs or a lift, five communal areas and a large garden where people could choose to spend their time. At the time of the inspection 26 people lived in the home.

A registered manager was 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.

Records were not always available to demonstrate people’s needs were assessed before they moved into the home, to ensure their needs could be met. In addition, the documents used did not always have a holistic focus. People told us they were always asked for their permission before personal care was provided. Staff adhered to the principles of the Mental Capacity Act, 2005 (MCA) but the records needed improvement. Risks associated with people’s needs and measures to reduce these were well known by staff but records did not provide sufficient guidance for staff who may not know the person they were supporting well.

The provider had introduced new governance systems which had identified areas for improvement. These had identified the same issues we found. The work to make these improvements had only just started at the time of our inspection and therefore needed more time for completion and to be fully embedded into practice.

There were sufficient staff to meet people’s needs. Staff were safely recruited although the registered manager’s records of this needed improvement. Staff understood their responsibility to safeguard people and had received training to do so. Medicines were managed safely. Improvements had been made to staff training and supervision although staff did not always receive training specific to people’s needs. We have made a recommendation about this. The home was clean, tidy and staff promoted good infection control management.

Staff knowledge of people was good and they provided person centred care. People were provided with appropriate mental and physical stimulation. People were treated with kindness and compassion. Observations reflected people were comfortable and relaxed in staff’s company. People were encouraged to be involved in their care and their independence was supported. People’s privacy and dignity was respected. People were supported to ensure they received adequate nutrition and hydration by staff who worked well as a team and supported access to appropriate healthcare services.

There was a process in place to deal with any complaints or concerns if they were raised. People told us they knew how to complain but had not needed to. The registered manager was accessible and operated an open-door policy. Staff were confident to raise concerns and felt listened to.

The provider was aware of the requirement to notify CQC of significant events that occurred in the home and this was happening.