Edgemont View Nursing Home

Edgemont is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The service can support up to 21 people.

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

Relatives described safe infection control procedures in place, when they visited the home. They told us there had been occasions when they felt more staff were needed, but understood staffing was a challenge across the sector at present and these were individual occasions rather than a general concern. Relatives raised no concerns about the care provided by staff and felt people were well cared for. Comments included, "never had any concern, staff come straight away when asked", and " there has always been staff around to ask questions."

We found that infection control procedures were followed in line with guidance set out during the pandemic. Staff wore masks and there were good supplies of Personal Protective Equipment (PPE) evident throughout the home. Staff described the procedures they followed whilst delivering personal care. There were suitable arrangements in place for visitors to the home. This included taking temperatures and making sure a Lateral Flow Test (LFT) was carried out.

There were sufficient numbers of staff to ensure people were safe and their needs met. During the day, there were four care staff plus a nurse. At night, one nurse was on duty and either one or two care staff.

Staff felt well supported by the registered manager and able to raise and report concerns. There were systems in place to monitor the quality and safety of the service

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 9 December 2021). The rating has not changed as a result of this inspection as this was a targeted inspection looking at specific concerns.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staffing, infection control and governance. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific 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.

Follow up

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

A newly appointed manager had been in post for four weeks at the time of our inspection. They had submitted an application to CQC 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 our last inspection in August 2016 we rated the service overall as Requires Improvement. This was because we found breaches in Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found people were not protected from the risks associated with cross infection, the service was not always well led and improvements were required. Provider visits needed to be more robust in order to support people who used the services. Auditing of the service and facilities was not effective or sufficient. In addition the service was not meeting a condition of their registration where there must be a manager registered with the CQC.

Following the inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of that regulation. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. In addition they had sustained previous good practice. As a result of this inspection the service has an overall rating of Good.

Why the service is rated Good.

Even though the manager had only been in post for four weeks their appointment had already significantly helped improve the previous lack of management of the service. Their previous experience as a registered manager had equipped them with the skills and knowledge required for their roles and responsibilities. It was evident they were confident and committed to embrace the new challenges and to improve the service. An increase in the provider’s oversight meant that a significant number of improvements had been made to help ensure that people were safe and received quality care.

Improvements had been made to help ensure people were protected from the risk of cross infection. This was because appropriate guidance had been followed. People were now cared for in a clean, hygienic environment.

The manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these.

People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Staff had the knowledge and skills they needed to carry out their roles effectively. They felt supported by the provider and the manager at all times. The manager and nurses had a good understanding of the Mental Capacity Act 2005 (MCA). The care staff understood it’s principles and the importance of supporting people to make decisions and protect their rights.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. Staff demonstrated a genuine passion and commitment for the roles they performed and their individual responsibilities. It was important to them those living at the service felt ‘valued and happy’.

People benefitted from a service that was well led. People who used the service felt able to make requests and express their opinions and views. Staff were embracing new initiatives with the support of the manager and provider. They continued to look at the needs of people who used the service and ways to improve these so that people felt able to make positive changes.

The provider and manager had implemented a programme of improvement that was being well managed. The manager and provider demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service.

There was a manager in post but they were not registered. 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.

Despite the views of people and their relatives, improvements were required in a number of areas.

People were not protected from the risk of cross infection. This was because appropriate guidance had not been followed. People were not cared for in a clean, hygienic environment. Monitoring of the quality of the service was not always effective.

The manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Medicines were managed safely and staff followed the services policy and procedures.

The provider’s recruitment policy and practices helped to ensure that suitable staff were employed. The manager and staff were able to demonstrate there were sufficient numbers of staff with a complementary skill mix on each shift.

People moved into the service only when a full assessment had been completed and the manager was sure they could fully meet a person’s needs. People’s needs were assessed, monitored and evaluated. This ensured information and care records were up to date and reflected the support people wanted and required.

Staff had the knowledge and skills they needed to carry out their roles effectively. People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People received a varied nutritious diet, suited to individual preferences and requirements. Mealtimes were flexible and taken in a setting where people chose. Staff took prompt action when people required access to community services and expert treatment or advice.

References were made by relatives and staff about the ‘family atmosphere and homely feel’. Staff were knowledgeable about people they supported and it was clear they had built up good relationships. Family and friends had completed surveys this year and expressed their gratitude to staff and the services provided.

The manager had settled in to their role and had started to look at how they would continue to improve the service for people and staff. The service was important to them and they wanted the best for people. There was an emphasis on teamwork and unity amongst all staff at all levels.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Following the inspection of November 2012 we saw that significant improvements had been made including new guidance for staff, additional training and updates, new equipment had been purchased. There was increased observation and monitoring at mealtimes and policies and procedures had been reviewed.

People were being looked after and supported appropriately by all staff. They were happy and positive about the home, the staff and the lives that they were living.

Staff were dedicated and wanted the best for people in their care. It was evident through observation and in discussions that they enjoyed working in the home and supporting people.

We were introduced to people, visitors and staff throughout the visit and we were welcomed. Some people remembered us from the inspection of March 2012 and were happy to share their experiences with us. We saw some good examples where people were cared for well and people told us they were happy living in the home.

One person told us, 'I have settled in very well, I have some very good relationships with staff and they cheer me up. It's all been very positive since moving here and I feel I am in good hands'. Other experiences and positive outcomes for people who use the service are referred to throughout this report.

Some areas of care required improvements and potentially put people at risk. Staff were receptive about what we had found and agreed that the quality and safety could be improved with additional training and support from colleagues and management. Staff we spoke with told us they were proud to work there and wanted to continue to improve the service they provided.