Edge Hill Rest Home

Edge Hill Rest Home is a residential care home providing personal care for up to 36 people. At the time of our inspection there were 31 people living at the home. The home is an adapted building set in its own grounds.

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

The introduction of an electronic medicines system had led to improvements in the management of medicines. Medicines were stored and administered safely, by appropriately trained staff. There were enough staff to meet people’s needs. Recruitment checks ensured staff were suitable to work in the care service. Staff were appropriately trained and received supervision and support from the management team. Staff had completed training in safeguarding and knew how to recognise and report abuse or neglect. Staff understood how to manage risks to people’s health and well being. The home was clean and well maintained and staff followed good infection control practices.

Leadership and management had improved since our last inspection.The registered manager had good oversight of the service and changes and improvements started following our last inspection were now embedded in the day to day running of the home. People received person-centred care from staff who knew them well. Quality assurance systems to monitor the service were in place and used effectively. There were procedures to ensure any accidents, incidents or complaints were fully investigated and people and relatives involved and informed of the outcome.

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 (report published 11 December 2020). We found one breach of regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out a comprehensive inspection of this service on 16 November 2020. A breach of legal requirements was found. The provider completed an action plan to show what they would do and by when to improve.

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 has changed from requires improvement to good. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Edge Hill Rest 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.

Edge Hill is a residential care home providing personal care for up to 36 people. At the time of our inspection there were 27 people living at the home. The home is an adapted building set in its own grounds.

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

We found improvements were needed in the management of medicines, particularly in relation to the documentation used to ensure safe medicines administration.

Previous management oversight of the service had been poor and action needed following our last inspection had not been fully implemented or maintained. However, a new management team was introducing improvements to the service and staff and relatives spoke positively about the changes.

Relatives told us they were happy with the care and support provided by staff. Staff told us they would report any safeguarding concerns and safeguarding training had been completed. Whistleblowing procedures had been strengthened.

Recruitment procedures were robust and there were enough staff to care for people safely. Staff had completed appropriate training and regular supervision had been re-introduced.

Correct infection control procedures were followed and the service had taken additional infection control measures to minimise the risk posed by COVID-19. The home was clean and free from odour.

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 (report published September 2019). There were two breaches of the 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 enough improvement had not been made and the provider was still in breach of a regulation.

Why we inspected

We undertook this inspection to check that the provider had followed their action plan and the service now met legal requirements. This report only covers our findings in the two key questions of safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained 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 Edge Hill 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 have identified a breach in relation to medicines documentation.

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 also 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Edge Hill is a residential care home providing personal care for up to 36 people. At the time of our inspection there were 22 people living at the home. The home is an adapted building set in its own grounds. Accommodation is over two floors.

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

The provider’s quality assurance and monitoring system for the management of medicines was not effective. This meant the storage and administration of medicines was not always safe and people were put at risk of harm.

The registered manager carried out monthly medicines audits. However, they were not robust enough, as they had not identified the concerns we found during our inspection. Staff who gave out medicines had been trained and assessed as competent to do this. However, we found concerns around the administration of medicines. This showed the training and competency checks were not robust.

Medicines were not always stored within the recommended temperature range. If medicines are not stored properly they may not work in the way they are intended.

The controlled drugs register had not always been completed correctly and in line with controlled drugs regulations.

Medicines administration records (MARs) had not always been completed accurately. We could not be sure people had received their medicines as prescribed. Some people had not received their medicines at the correct time. Although this was a dispensing error, by a pharmacist, the service had not taken any steps to seek clarification about the problem.

Risk assessments had not been completed for two people who managed their own medicines. This meant staff could not be sure the people were capable of looking after their medicines themselves.

Body maps to show where creams should be applied and where pain patches should be placed were not completed.

Some people with swallowing difficulties have their drinks thickened to prevent them choking. There was a lack of detail in people’s care plans about how much fluid thickener should be used. Fluid thickeners were not always stored securely.

We have made a recommendation about the way the way the service re-orders PRN medicines.

Rating at last inspection

The last rating for this service was good (report published 10 July 2018).

Why we inspected

The inspection was prompted by concerns raised at an inquest about some aspects of the management of medicines at the home. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led. We looked specifically at the management of medicines and the oversight of the registered manager and provider of these aspects of care.

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 the provider needs to make improvements. Please see the Safe and Well-led sections of this report.

Enforcement

We identified breaches in relation to the management of medicines and governance. You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

Following the inspection we took action to ensure the provider improved the management of medicines. We asked the local Clinical Commissioning Group (CCG) medicines optimisation team to carry out an audit of the management of controlled drugs at the home. We informed the local authority of our inspection findings.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service 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.

At our last inspection in June 2017 we rated the service ‘requires improvement’ overall, although we did not find any breaches of the Health and Social Care Act 2008. However, because the service had previously been in ‘special measures’ (because it had been rated ‘inadequate’ overall) we could not rate it as good until we could be sure it could adequately sustain the improvements it had made.

At this inspection we found the service had sustained its improvements and we have therefore rated it ‘good’ overall.

There were systems in place to help safeguard people from abuse. Staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people promptly.

The home was well maintained and attractively decorated and was free from any unpleasant odours. Staff used appropriate personal protective equipment (PPE), such as disposable aprons and gloves when carrying out personal care tasks. This protected people from the risk of cross infection. Maintenance checks on services and equipment were up-to-date.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

New staff received an induction to provide them with the skills to care for people. Regular face-to-face training was provided to ensure all staff updated their mandatory training annually. Staff received regular supervision and an annual appraisal. This gave staff the opportunity to discuss their work and training needs and for management to check staff remained competent.

Staff encouraged people to make choices where they were able. People’s independence was encouraged and promoted. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People who used the service were complimentary about the staff. We observed kind and caring interactions between staff and people who used the service. Care plans, which were reviewed regularly, were detailed and reflected the needs of each person.

We received mixed views about the quality of the food. Some people felt there was not sufficient choice or variety, while other people were happy with it.

People's day to day health needs were met by the staff and the service had good relationships with external healthcare professionals. A range of activities were provided.

Audits and quality checks were undertaken on a monthly basis and any issues or concerns addressed with appropriate actions.

Edge Hill Residential Care Home provides care and support for up to 36 people. It is a detached building situated approximately one mile from Oldham Town Centre and is surrounded by a large garden. There is a small car park to the rear of the property. At the time of our inspection Oldham Metropolitan Borough Council (OMBC) had put in place a temporary suspension on new admissions to the home, following a number of concerns raised by different health and social care professionals about aspects of the care provided. These included concerns about poor moving and handling practices, lack of meaningful activities, out-of-date support plans and poor staffing levels.

The service had a registered manager in place. 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 associated Regulations about how the service is run.

We found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014, which were in relation to unsafe moving and handling practices, poor infection control, poor food hygiene practices, inadequate staffing levels, poor training, failure to work within the principles of the Mental Capacity Act 2005, poor record keeping, failure to handle complaints correctly and poor governance. We made three recommendations. These were in relation to dignity and privacy, activities and staff handover meetings. You can see what action we told the provider to take at the back of the full version of the report. We are currently considering our options in relation to enforcement and will update the section at the end of this report once any action has concluded.

During our inspection we observed some staff using incorrect and unsafe methods for moving and repositioning people despite receiving training in this topic. We found that moving and handling risk assessments and care plans were not up-to-date.

Infection prevention and control measures were not fully implemented in order to protect people from the risk of infection, although the registered manager had taken steps towards rectifying this by purchasing handwashing posters and foot operated waste bins to install in the bathrooms and toilets.

Food hygiene practices were not thorough as we found opened, uncovered and undated food had been left in the fridge, and fridge and freezer temperatures in the kitchen had not always been monitored. This meant there was a risk that contaminated food could be given to people who used the service.

There were not always sufficient staff to provide prompt care and support to people who used the service. On one occasion we saw that a person had to wait for forty minutes before there were staff available to assist them to change their position.

The management of medicines was carried out in a safe way and those staff with the responsibility to administer medicines had been trained to do so.

Arrangements were in place to safeguard people from harm and abuse. Recruitment processes were robust and protected people who used the service from the risk of unsuitable staff being employed to provide care and support to vulnerable people.

Staff had received training in a variety of subjects which enabled them to carry out their roles. However, although staff had received training in moving and handling we observed some staff supporting people to move in an unsafe way.

One member of staff who was in their induction period and should have been working under supervision told us that they had assisted a person with their meal without the appropriate training.

There was a ‘fob’ system in place which prevented people who relied on assistance from staff to mobilise, from leaving the communal areas. This meant that the home was not working within the principles of the Mental Capacity Act (2005). Following a discussion with the registered manager and owner, the system was permanently deactivated.

We observed that staff were kind and caring in their interactions with people who used the service and the majority of comments about the staff were positive. However, we saw one example where a member of staff did not interact in a thoughtful manner with a person who used the service.

One person who was lying in bed was visible to us from outside their bedroom window. We have made a recommendation in relation to dignity and privacy.

Care and support records were not always up-to-date and therefore did not reflect people’s current needs. The registered manager had started the process of thoroughly reviewing and reorganising care files.

Although a number of outside entertainers visited the home, there were not sufficient meaningful activities available to provide people using the service with stimulation and opportunities to socialise.

There were systems in place to enable people to make a complaint about the service. However, the complaints policy had not been followed when a complaint had been received.

We received positive comments about the registered manager and during our inspection we found her helpful and receptive to suggestions we made to improve the service.

Some governance systems were in place to monitor the quality and safety of the service. However governance systems had not identified the issues raised by Commissioners prior to our inspection or the issues we found during this inspection.

People using the service, their families and staff were provided with opportunities to express an opinion about how the service was managed and the quality of service being delivered through surveys.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Edge Hill Residential Care Home provides care and support for up to 36 people. At the time of our inspection there were 16 people living at the home. It is a detached building situated approximately one mile from Oldham Town Centre and is surrounded by a large garden. There is a small car park to the rear of the property.

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.

At the last inspection on the 24 and 25 November 2016 we rated the service as ‘Inadequate' which meant it was placed in ‘special measures.’ At that inspection we identified five regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in relation to unsafe moving and handling practices, poor infection control, poor food hygiene practices, inadequate staffing levels, poor training, failure to work within the principles of the Mental Capacity Act 2005, poor record keeping, failure to handle complaints correctly and poor governance. We also made three recommendations. These were in relation to dignity and privacy, activities and staff handover meetings.

Following the inspection the provider sent us an action plan detailing how the identified breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

At this inspection we found significant improvements had been made and the provider was compliant with all the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. The service is therefore no longer in ‘special measures’. We have made one recommendation. This is in relation to Deprivation of Liberty Safeguards.

The home was well maintained and attractively decorated and was free from any unpleasant odours. Environmental checks of the home, such as for the gas and electricity supply were up-to-date. We identified a ladder propping open a door which was a risk to peoples’ safety. It was removed immediately. Work was underway to improve the garden environment.

Medicines were stored safely and were administered by staff who had received appropriate training and been assessed as competent to safely administer medicines.

We identified that a person had bed-rails in place without a robust assessment having been undertaken to ensure that this was safe. The registered manager to the appropriate steps to rectify this situation by referring them to the district nursing service for an equipment assessment.

Staff had a good understanding of the procedures needed to keep people safe and what action they should take in order to protect vulnerable people in their care. At the time of our inspection there were sufficient staff to respond to the needs of people promptly.

Staff had undertaken a variety of face-to-face training to ensure they had the skills and knowledge required for their roles. Staff supervision was undertaken regularly.

Two people who required Deprivation of Liberty Safeguards (DoLS) did not have these in place. Applications were submitted to the local authority during the course of our inspection.

People were complimentary about the caring nature of the staff and our observation of staff interactions with people during the inspection confirmed this. We saw that people were treated with dignity and respect.

A new documentation system had been introduced since our last inspection and we found the care plans were detailed and person-centred.

An activities co-ordinator had recently been employed at the home and we saw that there were a range of activities on offer.

The service had a complaints procedure in place and people we spoke with knew how to make a complaint. People told us they would speak to the registered manager, who they found approachable.

There was a programme of monthly audits to monitor the standard of the service. These included checks on medicines, food hygiene, dignity in care and health and safety.