Archived: Edward Moore House

Edward Moore House is a residential care home providing accommodation for persons who require nursing or personal care to up to 39 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 31 people living at the service.

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

Although the feedback from people living at Edward Moore House and their relatives was mainly positive, we found systems to monitor people's safety and well-being were not robust. Risks were not always identified and acted upon. Accidents and incidents were not effectively reviewed and monitored to minimise the risk of them happening again. Safeguarding concerns were not consistently shared with the local authority and The Care Quality Commission (CQC) to enable thorough investigation. Systems to monitor people's medicines were not robust which meant people may not receive their medicines as required.

People were not always supported by sufficient, skilled staff. Due to staff shortages the provider employed a large number of agency staff who did not know the people or the routines of the home as well as more permanent staff. Staff did not have comprehensive and accurate guidance around people's care needs as records were not updated regularly and contained contradictory information.

People were supported to access support from healthcare professionals. However, the outcome of people’s medical appointments was not always added to people’s care records. Changes in people’s health needs had not always been recorded to give staff clear information about how to support them safely. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s care was not planned in a way that centred on the individual and met the needs and wishes of people. There was a lack of activities. People had limited opportunities to go out unless supported by their family or friends.

Systems to monitor the quality of the service people received were not effective. Action plans lacked detail and timescales for completion were not met. Audit systems were not robust and did not identify concerns. The provider did not have adequate oversight of the service and did not ensure staff in positions of responsibility had the induction, training and support they required.

The provider had systems and processes in place to manage complaints. The provider’s records of informal complaints were not robust. We made a recommendation about this.

People told us they enjoyed their food. People and their relatives told us that staff were kind and caring in their approach. Comments included, “They are very nice here, all the carers”; “All the care staff are very friendly and informative”; “I’m all good friends with the staff here. They look after me well” and “The carers are good; they have a nice nature.” Permanent staff and agency staff (that had been regularly working at the service) knew people's needs well and individual interactions with people were pleasant. There was a calm atmosphere at 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 11 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about staffing and respecting people. A decision was made for us to inspect and examine those risks, during the inspection further concerns were found and a decision was made to complete a comprehensive inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, medicines management, safeguarding people from abuse, safe recruitment practice, assessment of needs, staffing training and induction, mental capacity, dignity and respect, person centred care, quality monitoring and improvement and duty of candour at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Abbeyfield – Edward Moore House is a care home providing accommodation and personal care for up to 39 older people. The service also offers a respite care service to enable people to stay in order to give their relatives and carers a break. At the time of our inspection 35 older people were living at the service, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility.

The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 6 October 2016 the service required improvement and we made two recommendations. These were about medicines management and staff supervisions. At this inspection we found that the provider had implemented our recommendations.

People were supported by staff who were trained to recognise the signs of abuse and who knew how to report concerns they had about people's safety. Checks were carried out on all staff so that that they were fit and suitable for their role.

Staffing levels had been reviewed and recruitment had started to ensure there was an additional member of staff on duty during the day in order to meet people’s needs.

Staff were trained in the safe administration of medicines, gained people’s consent before giving a person their medicines and appropriate records were kept.

People's care plans and risk assessments contained information about their personal history and support needs that enabled staff to support them safely. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

The environment was clean and had a number of design features which benefitted people living with dementia including themed areas, clear signage and books available to look at.

People had their health and nutritional needs assessed and monitored and referrals were made to health professionals when their needs changed. They were offered a choice at mealtimes which took into consideration their dietary requirements.

New staff received an induction which included shadowing existing staff. They were provided with a regular programme of training in areas essential to their role. Staff had received training in the Mental Capacity Act 2005 and understood its main principles. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager had submitted DoLS applications to ensure that people were not deprived of their liberty unlawfully.

Staff communicated with people in a kind manner and treated them with compassion, dignity and respect. Staff had developed positive and valued relationships with people and their family members. The service had received a number of compliments about the caring nature of the staff team.

A plan of care was developed for each person to guide staff on how to support people’s individual needs. Information had been gained about people’s likes, and what was important to them. These were regularly reviewed so that they contained the right information for staff to be able to support people. The service planned to develop a one page profile for people and staff and to match people who shared similar interests.

People were offered a range of activities which included sensory activities that took into consideration the needs of people living with dementia.

There were systems in place to monitor the quality of the service, which included gaining the views of people and their relatives. People felt confident to raise a concern or complaint.

The home had a manager who had been in post for 2 months and was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 undertaken on the 19 and 23 November 2015 we found a number of breaches of Regulation at that inspection and we rated the service as Requires Improvement. The breaches of regulation related to staffing levels, safeguarding people from abuse, managing accidents and incidents, managing medicines safely, and the cleanliness of equipment used to help people. We also required the registered provider to make improvements to the processes for, staff recruitment and training, meeting people’s nutritional needs, providing personalised care and monitoring and improving the quality and safety of the service. The provider sent us an action plan stating they would have addressed all of these concerns by January 2016 and this action had been completed. At this inspection we found the provider was meeting these regulations.

People’s care plans and risk assessments contained information about their personal history and support needs that enabled staff to support them safely. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

The medicines trolley was left unlocked and unattended on one occasion during the inspection. Medicines were administered and recorded safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. We have made a recommendation about the safe management and storage of medicines.

People were supported by staff who were trained to recognise the signs of abuse and who knew how to report concerns they had about people’s safety. There was a whistle blowing policy and staff were aware of their responsibility to report any bad practice. Policies and procedures were available for staff to support practice.

There was a sufficient number of staff deployed to meet people’s needs. There were robust recruitment practises in place to ensure that staff were safe to work with people. Staff received appropriate induction and training to ensure the safety and wellbeing of the people they cared for. We have made a recommendation about implementing and maintaining a robust supervision schedule.

People had access to health and social care professionals. Staff made appropriate referrals to health professionals for people when their needs changed.

People’s dietary needs were met. People did not always have access to food options that promoted their health and wellbeing. We have made a recommendation about meeting people’s dietary needs.

Staff knew people well and used their knowledge of people’s personal history to provide personalised care. People enjoyed interacting with the staff.

People were supported by staff who respected their dignity and privacy. Personal information about people was not discussed in communal areas.

People and their relatives were involved in assessments and monthly reviews of their care plans. Reviews also took place when a person’s needs changed.

Activities were planned and provided in a personalised way. People were offered activities based on their likes and dislikes. People’s rooms were decorated to reflect their personal preferences.

People and their relatives had access to the complaints procedure and they know how to make a complaint if they needed to. People and relatives’ feedback was sought through satisfaction surveys.

People, relatives and staff said the manager was approachable, took time to listen to them and had improved the atmosphere of the home. The manager had made improvements to the way the service was run so that people had greater freedom to access other communal areas within the building and the grounds. We have made a recommendation about sustaining a robust supervision schedule.

During the visit we met and talked with people that used the service, the manager, the care co-ordinator, senior care staff, care staff, and ancillary staff. They helped answer our five questions;

Is the service safe?

Is the service caring?

Is the service responsive? Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. We found overall that action had been taken and improvements had been made by management and staff since our last inspection visit.

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

Is the service safe?

The service was safe. People were treated with respect and dignity by the staff. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We observed that care records were being reviewed and regular auditing was undertaken to ensure that people were protected against the risks of inappropriate or unsafe care and treatment.

We inspected medication management and found that there were suitable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff.

We found that records required to be kept to protect people's safety and wellbeing were maintained, held securely and available when required.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and/or their representatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

We found that the staff referred people appropriately to their GP and other health and social care professionals. This meant that people had the care and treatment that they needed.

Is the service caring?

The service was caring. We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. People we spoke with told us that they were happy with the care they received and that they got the help they needed.

Is the service responsive?

The service was responsive. We found that the staff listened to people, and took appropriate action to deal with any concerns.

Care plans showed that the care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people. This meant that their health needs were being met.

Is the service well-led?

The manager was new to the home. Previous to this appointment, he was a registered manager with another of the homes owned by the company.

There were systems in place to provide on-going monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs.

The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.

People who used the service had their comments and complaints listened to and acted on effectively.

We were consistently told by people who use the service and relatives that the staff were very caring. Their comments included "I couldn't ask to be cared for by nicer people", "These people are just lovely and excellent at what they do" and "I never expected to receive such good care when I first moved in".

Throughout our inspection we saw that staff's approach towards people using the service was compassionate and respectful whilst maintaining a degree of professionalism. The atmosphere in the home seemed relaxed and staff were observed to be caring and supportive in their approach to people. We found that most staff appeared to know people using the service well and clearly understood their needs and preferences.

Staff told us that they were able to access the required training in order to deliver safe and appropriate care to people who lived in the home.

We found that the service had completed the appropriate checks in order to maintain a safe and suitable environment for people using the service.

At the time of our inspection we found that there were two registered managers for this location. Enquiries confirmed that only one manager was responsible for this location so we will take action to remove the other person from our register.