Edgecumbe Lodge Care Home

Edgecumbe Lodge care home is a residential care home providing the regulated activity of accommodation with personal care for up to a maximum of 21 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 15 people using the service.

Edgecumbe Lodge care home is a large, detached property in a residential area. The building has four floors with bathrooms on each floor. There is a lift and stairlift for accessibility.

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

This was a targeted inspection that considered the aspects of health and safety within the service in response to concerns received from the local authority. We found that some areas of health and safety had been rectified such as broken tiles in the porch had been fixed but there were a number of risks that had not been addressed. Some aspects of the premises and equipment were not clean or properly maintained which created a hazard around infection control.

The provider and registered manager’s oversight of environmental risk was poor. We identified shortfalls in this inspection that had not been identified by the provider. Fire safety was not always maintained in the home. Some fire doors on the ground floor of the home did not close properly. The Fire evacuation folder was not kept up to date. An electrical installation conditions report dated 08 August 2019 had identified a number of urgent remedial work that was required at the service, this had not been carried out in a timely way.

The provider’s internal governance processes did not highlight the concerns we found at this inspection. Quality assurance and monitoring was carried out but was not effective. However, further work and more regular audits were required both at manager and provider level, so that the service improved for people living in the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement (published 04 April 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about health and safety. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with environmental risks, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well led sections of this full report.

Enforcement

We found several breaches of regulation and issued the provider with warning notices in relation to premises and equipment and good governance.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Edgecumbe Lodge Care Home is a residential care home providing accommodation and personal care to up to 21 people. The service provides support to older people and those who are living with dementia. At the time of our inspection there were 16 people using the service.

Edgecumbe Lodge Care Home is located in a large detached property in a residential area of Bristol. Accommodation is provided across 4 floors with lift and stairlift access and bathroom facilities on each floor.

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

Medicines were not always managed safely. We found no evidence that people had been harmed, but staff did not always follow relevant guidelines about storing medicines and giving them to people.

The service did not always use effective infection prevention and control measures to keep people safe. Although improvements had been made since the last inspection, some areas of concern remained which made it difficult for staff to consistently apply good infection control practices. The service supported visits for people living in the home in line with guidance.

Governance processes were not always effective. Although audits were in place, these had not always highlighted the shortfalls we identified during the inspection. Improvements had been made, but further work was required.

Improvements had been made relating to the safe storage of oxygen and standards in the kitchen. Staff managed the safety of the living environment and equipment in it through checks. Fire safety was monitored, and actions taken as required to manage risks.

Staff knew people well and understood how to protect them from abuse. The service worked with other agencies to do keep people safe.

People were protected from the risk of harm because the service assessed, monitored and managed the risks associated with their care. Risk assessments were in place, regularly reviewed and shared with staff.

The numbers and skills of staff matched the needs of people using the service. Staff were recruited safely by the provider and there was an experienced staff team who knew people well and provided consistency.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

During the inspection we observed a relaxed, calm and inclusive atmosphere in the home. People appeared comfortable speaking to staff and asking them for support when required. We received positive feedback about the service.

Staff were motivated and committed to providing high quality care to people and ensuring their needs continued to be met. Staff told us the culture was ‘good’ at the service and they felt well supported by the management team and their colleagues.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 08 April 2022).

At that inspection we found there were breaches of two regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made, however different areas of concern were identified. This meant the provider remained in breach of regulations.

The service remains rated requires improvement. This service has now been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 16 March 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safety relating to infection prevention and control and safe storage at the home and operate effective processes to monitor quality and safety.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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

Enforcement

At this inspection, we have identified breaches in relation to safe care and treatment and the monitoring of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Edgecumbe Lodge is a care home providing accommodation and personal care for up to 21 people. At the time of the inspection there were 17 people living at the home. This is a Georgian home that has been converted and extended over three floors. There were two communal lounge/dining areas. People also have access to a large garden and balcony area.

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

Oversight of the quality of the service provided and audits carried out had not always been effective in identifying areas for improvement and ensuring they were completed in a timely manner.

Systems to protect people from harm in respect of food hygiene was not robust. Although the provider’s audit had identified areas for improvement in January 2022 these had not been rectified in March 2022 when the home was inspected by environmental health.

Staff were not always wearing face masks in accordance with the guidance, which put people at risk of catching COVID.

Oxygen was not stored safely and in accordance to the manufacture’s guidance. One person’s bedroom door was propped open who had been prescribed oxygen. This was a potential risk in the event of a fire.

The home was clean and free from odour. Cleaning schedules were in place and showed that high pressure points such as door handles, remotes were being cleaned frequently. People were supported to keep in contact with family in line with the government guidance. Testing was in place for staff and visitors to keep people safe.

People and relatives spoke positively about the staff working in the home telling us they were kind and attentive. Relatives felt the home was safe and people were well cared for. People’s medicines were managed safely. Risk assessments were in place to keep people safe such as moving and handling, skin integrity and malnutrition.

Staff were recruited safely to ensure people were protected. There was sufficient staff in place to support people. Staff received training that was regularly updated. This included infection control training and updates to keep people safe during the pandemic. Further food hygiene training was planned for all staff in response to a recent environmental health visit. The manager and the staff were working through the action plan to make improvements in this area.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff sought people’s consent to ensure they were happy with the support being given. Where people lacked mental capacity best interest meetings were held in relation to the care and treatment. Applications were made for a deprivation of liberty where this was appropriate.

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

Rating at last inspection and update

The last rating for this service was good (report published 10 October 2018). We completed two infection control assurance inspections (published 8 December 2020 and 20 August 2021). This type of inspection was not rated.

Why we inspected

The inspection was prompted in part due to concerns we received about the management of risk in relation to the environment and food safety. A decision was made for us to inspect to ensure people received safe care and monitoring systems were in place. As a result, we undertook a focused inspection to review the key questions of safe and well-led and examine those risks.

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.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Edgecumbe Lodge on our website at www.cqc.org.uk.

Enforcement

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 safe care and treatment and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

Edgecumbe Lodge is a care home providing accommodation and personal care for up to 21 people. At the time of the inspection there were 14 people living at the home. This is a Georgian home that has been converted and extended over three floors. There were two communal lounge/dining areas. People also have access to a large garden and balcony area.

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

The manager and staff understood their role and responsibilities to keep people safe from harm. People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained good. One visiting professional told us, “The staff were approachable and helpful, the manager was efficient and organised, and records were well kept”.

People were supported to take risks and maintain their independence. Risks were assessed and plans put in place to keep people safe. Where improvements were required the manager had taken action to improve safety and quality. There were enough staff to safely provide care and support to people. Checks were carried out on staff before they started work, to assess their suitability to support vulnerable people. Medicines were managed safely, and people received their medicines as prescribed. People were protected by the homes infection control policy and procedures.

The manager and staff maintained a focus on seeking to improve the service people received and learnt lessons when things had gone wrong. Staff genuinely cared for the people they supported and were proud to be in their roles. Comments included, “When I help someone to empower themselves it is an amazing feeling and I know that our residents are safe and it fills me with a sense of pride”, “I take pride in my job and always feel like I have made a difference” and “I feel proud to go home after work as it makes me feel happier, helping people to improve their lives”.

Quality assurance systems were in place and based upon regular, scheduled audits, which identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.

Rating at last inspection

The last rating for this service was Good (published in November 2018).

Why we inspected

This inspection was prompted in part due to concerns received about keeping people safe and how this is supported by people’s individual risk assessments. In addition, due to unforeseen circumstances there had been some change and inconsistency in the management structure and provider oversight. A decision was made for us to inspect and examine those areas of risk and all key questions in Safe and Well Led. We found no evidence during this inspection that people were at risk of harm. Please see the Safe and Well Led section of this report.

We also 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.

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

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.

Edgecumbe Lodge Care Home provides accommodation and personal care for up to 21 older people, including some who are living with dementia. Sixteen people were living at the service at the time of our inspection.

We found the following examples of good practice.

• Staff greeted visitors and carried out checks to reduce risk and avoid the potential spread of infection. Personal protective equipment was provided to visitors if needed, and they were supported to follow the provider's infection prevention and control procedures.

• People had been supported to keep in touch with families. Visits had recently been suspended, but staff assisted people to make phone and video calls. Visits had been taking place in the open, but a plan was in place to install a semi-permanent marquee for visits as the weather became more inclement.

• Staff worked only one on floor of the service to reduce the risk of spreading infection. When agency staff were used, they worked at the service for several days to ensure they knew people well and did not work at any other care home.

• Staff wore appropriate personal protective equipment (PPE). Sufficient supplies of PPE were in place. Staff had received training in infection prevention and control measures and were confident in the safe use of PPE.

• The provider was supportive towards staff who were at high risk because of existing health conditions. Staff were supported financially when they were not able to be at work and the provider gave financial enhancements and bonuses.

• The provider was aware of current admissions guidance, and ensured this was followed within the service. Staff worked closely with other agencies and health professionals to ensure people were safe and their needs were met.

Further information is in the detailed findings below.

There was a registered manager 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.

At our last inspection in July 2017 we rated the service overall as Requires Improvement. At that inspection we found some breaches in our regulation had been fully met, some had been partially met and we needed to be satisfied that the improvements made would be sustained.

The registered manager told us, “Our focus has been around sustaining and continuously improving the quality of the service we provide in a safe environment, this specifically relates to maintaining infection control measures and safe practices, maintaining the building, premises/equipment and maintaining compliance checks and audits. One new initiative has been the managers walk around which is completed weekly with the aim of identifying areas of improvement before things fall back, this is a complimentary process to the service audit around the environment”.

At the time of the inspection the service had improved and people received a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm. People were supported to take risks and promote their independence. Risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Medicines were well managed and people received their medicines as prescribed. Infection control policy and procedures were followed.

At the time of the inspection the service had improved and people received a service that was effective. Staff received regular supervision and the training needed to meet people’s needs. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice.

We were introduced to people throughout our visit and they welcomed us. They were relaxed, comfortable and confident in their home. The feedback we received from them was positive. Those people who used the service expressed satisfaction and spoke highly of all staff. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner.

The service had sustained previous improvements and staff were responsive to people’s needs. People received person centred care and support. Staff monitored and responded to changes in people’s needs. They were knowledgeable about people's lives before they started using the service. Improvements were required to enhance this knowledge so that their life experiences remained meaningful.

At the time of the inspection the service had improved and people received a service that was well led. The registered manager and staff team maintained a clear focus on continually seeking to improve the service people received. Quality assurance systems were in place and based upon regular, scheduled audits which identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.

Further information is in the detailed findings below.

There was a registered manager 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.

At our last inspection in June 2016 we rated the service overall as Requires Improvement. At that inspection we found breaches of Regulations 12, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following that inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of those regulations. At this inspection we saw the provider had taken action as identified in their action plan. As a result improvements had been made. However although some breaches had been fully met, some had only been partially met and we needed to be satisfied that the improvements made would be sustained.

As a result of this inspection the service remains rated overall as Requires Improvement.

The appointment of the registered manager had helped rectify previous poor management of 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. Improvements were still required to ensure infection control audits were completed regularly in order to ensure good practice was sustained.

Previously there were some areas where safety had been compromised because of the environment and poor maintenance. Although improvements had been made further improvements were required. Some maintenance checks regarding the safety of the premises had lapsed. Personal evacuation plans in the event of an emergency, had been reviewed and updated to protect people in the event of a fire.

At our previous inspection we found monitoring of the quality of the service had lapsed; audits had not been consistently applied and were not robust enough to ensure quality and safety. In addition the provider lacked knowledge and understanding about their legal obligations. Quality audits had now improved and provided clear accounts of monitoring of the service provision, they helped identify where further improvements were required. Some audits had not been completed but this had been rectified by the end of this inspection. We (CQC) need to be satisfied that these will be sustained in the future.

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 provider’s 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 were helped to exercise choice and control over their lives wherever possible. Where people lacked capacity to make decisions best interest decisions had been made. The Mental Capacity Act (MCA) 2005 and 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 the setting people chose. People enjoyed receiving visitors and had made friends with people they lived with. They were relaxed in each other’s company. Staff had a good awareness of individuals' needs and treated people kindly. Staff were knowledgeable about everyone they supported and it was clear they had built relationships based on trust and respect for each other.

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.

The registered manager had settled into their role and had started to look at how they would continue to improve the service for people and staff. They had forged good relationships based on trust and confidence with everyone who used the service. 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 one breach 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.

The registered manager had recently left the service. The Directors were actively recruiting at the time of out inspection. 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.

Previous poor management of the service and the lack of the provider’s oversight meant that a significant number of improvements were required to ensure that people were kept safe. 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. People had personal evacuation plans in the event of an emergency, but they were out of date and did not reflect how to protect people if there was a fire. There were some areas where safety was compromised because of the environment.

The arrangements in place to ensure that the service was well led were unsatisfactory. Monitoring the quality of the service had lapsed; audits had not been consistently applied and were not robust enough to ensure quality and safety. People’s views and experiences were not sought through quality assurance systems. The provider lacked knowledge and understanding about their legal obligations.

The provider and Directors had identified a deterioration in the service provision earlier this year and it was acknowledged that significant improvements had been made. This included promoting a person centred approach to care, improved effective training and increased supervision and support for staff. Staff were keen to share their views about the service and what it was like to work there. All staff were feeling positive and supported and welcomed all the new initiatives being introduced. One relative said, “Despite recent problems I do feel that the home has that family feeling and staff care about the people they support”.

People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions best interest decisions had been made. The Mental Capacity Act (MCA) 2005 and 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 action when people required access to community services and expert treatment or advice.

People enjoyed receiving visitors and had made friends with people they lived with. They were relaxed in each other’s company. Staff had a good awareness of individuals' needs and treated people kindly. Staff were knowledgeable about everyone they supported and it was clear they had built up relationships based on trust and respect for each other.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives and with staff, and looking at records.

Is the service safe?

People told us that they felt safe living at the home. Risks relating to people's health and care needs were being identified. People's medication was kept securely and being managed safely.

Facilities and equipment in the home were being regularly checked to ensure they were safe and working correctly. Aids were being used to assist people with their mobility; staff had received training so that they knew how to use this safely with people.

Is the service effective?

People told us that the home was meeting their needs. Individual care plans had been produced which set out the support they would receive. This provided guidance for staff, who assisted people in ways which helped them to maintain their independence.

People were supported with seeing healthcare professionals to ensure that their individual needs were met. Staff told us that people received good support from the community nurses who came to the home.

Is the service caring?

The relationships we observed between staff and the people who used the service appeared to be friendly and positive. Staff talked to people in a respectful way and took time to explain what they were doing, for example when administering medicines.

Relatives we met with said they were made to feel welcome during their visits. One relative told us that people looked well supported with their personal care when they visited.

Is the service responsive?

People were asked about their choice of meals, which were prepared in ways which met people's individual needs.

Surveys were being used to gain the views of the people who used the service, their relatives and staff. The feedback provided information about what was working well and how the service could be improved.

Is the service well-led?

The service has a manager who is registered with the Commission. Support was provided by a deputy manager who had specific areas of responsibility. Some staff were in the role of seniors; they took the lead on each shift and were available to support the care workers as needed. This showed that there was a structure in place for overseeing the day to day running of the home to make sure that the appropriate procedures were being followed.

People had their care needs assessed and planned and staff told us that there was good communication within the team if people's needs changed. A relative told us they thought the standard of care was good and that they were kept informed of any concerns. The people we spoke with were satisfied with the care they received.

Professionals from other services told us that staff at the home were cooperative and knowledeable about the people they cared for.

The home was clean and free of odours. Feedback from people and their relatives indicated they were satisfied with the cleanliness of the home. The provider had a system in place to manage the risk of infection and their was guidance for staff on maintaining a clean environment.

The provider carried out appropriate checks before people were employed at the home.

The provider had an effective system to monitor the quality of the service, which included seeking the views of people living in the home, their relatives and staff. There was an effective complaints system and people and their relatives were confident they would be listened to and action taken

At the inspection of February 2012 people told us they were happy with the care they received from staff at the home. Concerns were raised at our previous inspection with regard to record keeping. Standards of reporting to external agencies was poor. The condition of the premises and furniture was poor, risks and hazards in the environment had not been identified or addressed. People could not be sure that there were enough staff who were sufficiently supported and trained. The provider did not have effective systems in place to monitor the quality and safety of the service.

At our inspection of 1 October 2012 we found that care records now recorded people's care needs, were regularly reviewed and that consent was routinely obtained from people living at the home. Staff had received training in safeguarding vulnerable adults and the Mental Capacity Act 2005. The home was being refurbished and the grounds landscaped.

The numbers of staff had been increased with separate staff to carry out domestic and kitchen duties.

The provider had not yet developed effective infection control policies and procedures or quality monitoring systems however, improvements had been made in both these outcome areas.