This inspection was unannounced and took place on 2 and 14 February 2017. St Edmunds Residential Home provides accommodation and care for up to 39 older people. It is not registered to provide nursing care. At the time of our inspection there were 35 people living in the home. A new manager was in post and an application for them to become registered was being processed by CQC. 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 and July 2016, we found the provider was in breach of four of the
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found improvements had been made and the provider was no longer in breach of these regulations.
People were safe living in the home. The provider had completed the required remedial works to ensure the safe management of water systems and staff had completed training in Legionella.
The systems for medicines management and administration had improved. Medicines were managed safely and people received their medicines as prescribed. An air conditioning unit had also been installed in the medicines room, to ensure medicines were stored at the correct temperature. Staff who administered medicines had undergone competency assessments.
The management team were using a dependency tool to help ensure sufficient staff were on duty to meet people’s needs. Additional staff had been recruited to cover identified shortfalls in staffing levels. Staff deployment and staff breaks had been revised, to ensure enough staff were available to support people during mealtimes.
A proactive and positive approach to risks was being taken by staff and the management team. Staff and the management team worked collaboratively with other professionals to ensure risks to people were managed properly. Risk assessments had been reviewed and updated with people and their GPs, in respect of any possible adverse effects caused by drinking alcohol when prescribed certain medicines.
Infection prevention and control was being managed safely. The domestic team worked in accordance with advice received from the NHS Infection Prevention and Control Team.
Risks were identified and appropriate risk assessments were in place with regard to protecting people from developing pressure sores. Staff had received training in care planning and the format of care plans had been revised to ensure information regarding such risks would not be missed.
The risks to people from not eating or drinking enough were well managed. People’s weights were being recorded appropriately, to ensure people were protected from the risk of malnutrition and people had easy access to drinks when they wanted them. Staff had received training to ensure the correct and complete recording of people’s food and fluid intake and the management team ensured these records were appropriately maintained.
People were offered choices of food and drinks at mealtimes and menus were available in the dining and communal areas. The cook maintained an up to date list of people’s dietary requirements and diabetic diets were catered for appropriately.
Staff were recruited in a way that ensured proper checks were carried out. This helped ensure only staff who were suitable to work in care services were employed.
Staff knew how to recognise different kinds of possible abuse and understood the importance of appropriately reporting any concerns or suspicions that people were at risk of harm.
Staff were being trained well and were competent in meeting people's needs. Staff understood people's backgrounds and preferences and supported people effectively. New staff were required to complete a probationary period and induction and all staff received supervisions and appraisals of their work.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. Improvements had been made in this area. Staff and the management team understood the MCA and DoLS and how to provide support in accordance with it. People were supported to understand and make decisions regarding their care and support needs.
Staff understood the importance of supporting people to make their own choices regarding their care and support. Staff consistently obtained people’s consent before providing support and, if people lacked capacity to make some decisions, staff understood how to act in people’s best interests to protect their human rights.
Staff had developed respectful and caring relationships with the people they supported and consistently promoted people’s dignity and privacy. People were able to choose what they wanted to do and when. People were also supported to develop and maintain relationships with their friends and families.
Care plans had been revised and updated. These were accurate and were being reviewed regularly with people. Care plans provided guidance for staff on how to meet people’s individual needs.
A new activities coordinator had been appointed and people engaged in a number of activities both inside and outside of the home. People were also supported to maintain and enhance their independence as much as possible.
The service was being run well and communication between the management team, staff, people living in the home and visitors was frequent and effective. People and their families and friends were able to voice their concerns or make a complaint if needed and were listened to with appropriate responses and action taken where possible.
Effective systems and processes had been introduced to monitor the quality of the service provided. Regular audits were carried out in order to identify any areas that needed improvement, which were then acted upon.
There was an inclusive and positive atmosphere in the service. The management team listened to people and staff and took action in response to their views. Staff spoke positively of the manager, as well as the management team as a whole, and the changes that had taken place since our last inspection.