Eden Place Mental Health Nursing Home

Eden Place Mental Health Nursing Home is a residential care home providing personal and nursing care to up to 33 people. The service provides support to younger and older people with mental health needs including people who need care and accommodation for substance misuse. At the time of our inspection there were 31 people using the service.

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

Overall, we were assured by the infection, prevention and control practices in the home but found cleanliness and hygiene in some of the shared bathrooms could be improved.

Staff received safeguarding training and risks to people's health, safety and wellbeing were assessed and used to develop holistic assessments of need and care management plans. There were enough staff to support people safely and respond to people’s needs in a timely way. Medicines were ordered, stored and administered safely. Overall, we were assured by the service’s infection control practices and policies but found some shared bathrooms needed cleaning. The registered managers worked with domestic staff to ensure expectations around cleanliness and hygiene were maintained. Only staff trained to administer medicines could do so. Accidents and incidents were reported and recorded by staff and monitored by the registered manager.

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.

People had person centred care plans which provided staff with information on how people wanted to be cared for, their likes and preferences. Individual and group activities took place and people were encouraged to contribute their ideas and suggestions for day trips and outings. There was some signage around the home, for example to tell people where toilets and bedrooms were located. Planned activities were displayed on a community board, which were confirmed on a daily basis by staff checking which activities people would enjoy. People and their relatives told us they had no complaints and felt if they needed to discuss a concern, staff would be approachable.

We received positive feedback from staff at Eden Place and they were keen to share their experiences during the inspection. Improvements had been made to systems which monitored the quality and safety of care. Residents meetings and key worker progress reports were used to engage people who lived at Eden Place and give them an opportunity to contribute to care planning. Networks such as Skills for Care and nurses support groups were used by the registered managers to share knowledge, keep up to date with good practice and aid continuous professional development.

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 17 October 2019).

Why we inspected

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

We undertook this focused inspection to check whether improvements had been made at the service since we last inspected. This report only covers our findings in relation to the key questions Safe, Responsive 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.

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 has changed from requires improvement to good. 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 Eden Place Mental Health Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eden Place is a mental health nursing home, which provides care for up to 34 people over three floors. People had their own bedrooms and some had en-suite facilities whilst others shared communal bathroom facilities. People had access to communal lounge and dining areas and a secure outside area. At the time of our inspection there were 32 people living at Eden Place.

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

At our last inspection we found breaches of the regulations. These related to good governance as the provider had not taken responsibility to ensure the premises and equipment were safe, maintained or fit for use. At this inspection, we found sufficient improvements had been made to meet the regulations. However, further improvements were still required to ensure the service was consistently safe and responsive to people’s needs, and audits were used to ensure a quality service was provided.

Since our last inspection, improvements had been made in the environment. Some refurbishment of communal bathrooms had taken place, along with some redecoration of the home. Further redecoration was planned for. Outstanding gas safety work had been completed and environmental safety checks had improved.

Staff knew people well and how to protect them from harm, but did not always have important information to refer to if needed. Staff had received training on how to protect people from the risks of abuse and understood the importance of reporting any concerns.

The home was clean and odour-free and staff understood how to reduce the risks of spreading infection. People had their prescribed medicines available to them and were supported with these from trained care staff or nurses.

There were sufficient staff on shift to meet people's needs and the provider had a safe recruitment system to ensure staff’s suitability to work at the home.

People’s needs were assessed before they moved in to live at the home. They had choices about how they spent their time and were supported by staff who worked within the principles of the Mental Capacity Act 2005.

People’s hydration and nutritional needs were met, and choices were offered. People were supported to access healthcare professionals whenever needed.

Positive caring interactions took place and staff promoted people’s independence. People’s privacy and dignity was respected.

Activities took place inside and outside of the home. People were supported to practice their faith if they chose to. Relatives felt their family member was well cared for and had no complaints. There were some systems in place for people and their relatives to give their feedback on the service, such as ‘resident meetings’.

The manager’s checks did not always identify when staff had not completed records as required. Further improvement was required to the managerial oversight through audits to ensure these were robust and identified any issues where improvements were needed.

Rating at the last inspection

The last rating for this service was Requires Improvement (published 3 October 2018) and there were breaches of the regulations. The provider submitted actions plans to tell us what they would do and by when to improve. At this inspection, whilst some improvements had been made and the provider was no longer in breach of the regulations, further improvements were required. The rating for the service continues to be Requires Improvement.

Why we inspected

This was a planned inspection based on the rating of the last inspection.

Follow up

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

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

Eden Place is a mental health nursing home, which provides care for up to 34 people over three floors. At the time of our inspection there were 32 people living at Eden Place. People had their own bedroom and some bedrooms had en-suite facilities whilst others shared communal bathrooms. Eden Place had a secured outdoor area and was monitored externally by CCTV, with the entrance to the home accessed by an electronic gate.

People in care homes receive accommodation and nursing and/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.

A requirement of the service’s registration is that they have a 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 and the associated Regulations about how the service is run. At the time of our inspection visit there was a registered manager, however they were away from the home on maternity leave. An interim manager had been appointed to cover this absence from 6 August 2018.

At our last comprehensive inspection in September 2017, we rated the service ‘Requires Improvement’ overall. At this inspection we found the evidence continued to support the rating of Requires Improvement. This was because there remained limited understanding of working within the principles of the Mental Capacity Act 2005. The provider’s quality assurance systems required greater improvement and because there continued to be limited improvement, we found this was a continued breach of the regulations. Some improvements since the last inspection had been addressed, for example, medicines management and the provider had submitted statutory notifications to us when notifiable incidents had occurred.

Care plans required more personal and individualised information for staff to provide care to people in a more person-centred way. For people who had recently moved to Eden Place, a lack of detailed care plan information meant staff did not have the knowledge they needed to know about that individual. For people assessed as being at risk, risk assessments needed more information so staff could manage risks to people safely.

Staff protected people from risks of abuse. All staff understood what actions they needed to take if they had any concerns for people's wellbeing or safety. Staff felt confident to raise concerns to the management and provider.

Staff received regular refresher training to meet people’s needs, and effectively used their skills and experience to support people. People’s care and support was provided by a caring and consistent staff team and there were enough staff to provide care when people needed it.

Staff did not always work within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge was not always consistent to ensure people received the right level of support. Care records did not always include the support people needed to make specific decisions where they lacked capacity.

Staff were caring in their approach and interactions with people. However, the lack of investment in keeping the environment safe and risk free showed the provider had not always considered how their actions impacted on those in their care.

There was limited stimulation for people to be involved in leisure interests to keep them active and to have fulfilling lives. People and staff were working together to help promote their social and lifestyle skills.

Staff supported people to ensure they maintained a balanced diet and people had choice of what they wanted to eat and drink.

People received support from other healthcare professionals to ensure their overall mental health and physical wellbeing was met. Regular checks and monitoring ensured medicines continued to be given safely by trained and competent staff. Time critical and patch medicines were given safely in line with their prescription.

Health and safety checks and environmental checks were not always identified and rectified to protect people from unnecessary risks. Some risks within the home such as water temperature checks, fire safety risks and risks associated with leaving cleaning liquids unattended, where not always realised which put people at unnecessary risks.

Examples of audits and checks were completed but further improvements to audits and checks had been recognised by the manager following our visit. Some checks had been completed with limited understanding of what was correct and there remained limited records to show what actions had been taken. The manager told us they planned to improve the service and wanted people’s experiences to be positive and what they deserved. The manager gave us a commitment that actions would be taken following our visit.

We found a continued breach and an additional breach of the Health and Social Care Regulations. You can see what action we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below.

Eden Place Mental Health Nursing Home is registered for a maximum of 33 people offering accommodation for people who require nursing or personal care and requiring treatment for substance misuse. At the time of our inspection there were 31 people living at the service. People using the service were being supported with their mental health needs and no one was requiring treatment for substance misuse. Eden Place was last inspected by us in July 2015, and we rated the home as Good.

The home had a ‘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.

People’s medicines were not always administered as prescribed, and medicines records did not always demonstrate that medicines were administered consistently. Some prescribed creams were being administered by care staff who had not been trained to do so. Audits designed to check medicines practice was safe and in line with best practice had not identified some of the issues we found.

Action had not always been taken to keep people safe in response to incidents that took place within the home.

Where people did not have capacity to make their own decisions, this had not always been assessed and documented. It was not always clear who was authorised to make decisions in people’s best interests, and applications to deprive people of their liberty had not always been made as required.

Systems in place to check the quality of the service provided were not effective, as they had not identified the concerns we found during our inspection. The provider had not always notified us of incidents that occurred in the home which is their legal requirement to do.

People told us they felt safe with the staff who supported them, and we saw people were comfortable with staff. Staff received training in how to safeguard people and understood what action they should take in order to protect people from abuse. The provider ensured staff followed safeguarding policies and procedures.

There were enough staff to meet people’s needs effectively. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people. Staff told us they had not been able to work until these checks had been completed.

People were asked for their consent before staff supported them. People had access to health professionals when needed and care records showed support provided was in line with what had been recommended.

People were offered a choice of meals and drinks that met their dietary needs, and where they were at risk, their food and fluid intake was recorded and action taken where required.

People and relatives told us staff were respectful and treated people with dignity. We observed this in interactions between people, and records confirmed how people’s privacy and dignity was maintained. People were supported to make choices about their day to day lives. For example, they were supported to maintain any activities, interests and relationships that were important to them.

People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication needs, their likes, dislikes and preferences. People were involved in how their care and support was delivered.

People and relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. People and staff told us the management team were approachable and responsive to their ideas and suggestions.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with six people living at Eden Place Mental Health Nursing Home who told us about their experiences of the service. We spoke with three members of staff and the manager.

People we spoke with told us that their care plans were discussed with them on a regular basis. We saw that people were involved with the reviews of their care and where possible, they had signed their care plan.

We saw that staff listened to people about their care needs and their wishes. We saw people's independence was promoted within their care plans and on the day of our inspection.

We saw quality assurance checks had been implemented and the manager told us how these worked. We saw that meetings had been held for people who lived at the home.

We saw people's care records, including risk assessments, were accurate and fit for purpose. We reviewed six care plans and found the records were easily accessible.

People we spoke with told us that the care planning was not discussed with them. We found there were regular reviews of people's care but it was not clear how people or relatives had been involved. We saw people's independence was promoted within their care plans and on the day of our inspection.

We saw that the care plans were person centred and reflected people's individual needs. We found the member of staff supported people as detailed within their care plans. We noted they were compassionate and caring when supporting people.

We found the home was clean and there was a cleaning schedule which the member of staff followed. We saw checks were made by the member of staff to review the cleanliness of the home.

We saw the provider ensured that the appropriate checks were undertaken before a new member of staff was employed. The manager told us about the induction plan which new staff had to complete during their employment by Eden Place Limited.

We found the service did not have a robust system in place to monitor the quality of care plans.

We saw care plan records were not always fully completed as some sections remained uncompleted. We found the records were unclear on whether the care plan was current or if there had been any amendments to the plan.

We spoke with two people living at Eden Place Mental Health Nursing Home who told us about their experiences of the service. We spoke with two members of staff, the deputy manager and the manager.

People we spoke with told us they were happy with the service and 'liked' it at Eden Place Mental Health Nursing Home. People also told us that staff were friendly and supported their needs.

We spoke with staff who told us how support for staff had improved since our last inspection. They told us that teams are been restructured and the sharing of information between the team had improved.

We saw quality assurance checks had been implemented and the manager told us how these worked. We saw that resident meetings were held and a resident survey was due to be undertaken.