CQC report explained · a residential care home
What the CQC found at Edward House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, September 2020
Edward House is rated Requires Improvement; inspectors found improved, person-centred care, but risks and records were not always managed safely, and the home is no longer in Special Measures.
Inspectors carried out an announced focused inspection on 22 July 2020. They visited the home, observed care, spoke with people, relatives, staff and managers, and reviewed care plans, medicines records, staff records and quality checks.
There had been clear improvements since the previous inspection. People felt safe, staffing levels met people's needs, medicines were managed safely and care was more personalised. Social activities and family contact had also improved, despite COVID-19 restrictions.
Some important risks were still not managed consistently. These included people's fluid intake, infection control practice by some senior staff, and incomplete or inaccurate care records. The home breached Regulation 12 on safe care and treatment.
The overall rating remains Requires Improvement. Safe and Well-led were rated Requires Improvement, while Responsive improved to Good. The home was no longer rated Inadequate in any key question and was no longer in Special Measures.
Improved leadership
People, relatives and staff described a happier atmosphere and said management had made significant improvements. Managers welcomed feedback and took action when concerns were identified.
“The leadership and management of the home had significantly improved.” from the report
Personalised care
Staff had better information about people's histories, interests and preferences. Activities and the environment were adapted to help people enjoy meaningful experiences.
“People received care that met their interests and preferences and told us they were happy living at the home.” from the report
Staffing and medicines
People said there were enough staff to meet their needs. Medicines were given according to prescribing instructions, and only trained and assessed staff were allocated to administer them.
“People were supported by suitably qualified staff and received safe and appropriate support which included access to their prescribed medicines.” from the report
Activities and family contact
The home arranged events, garden activities and ways for people to contact family and friends when visits were restricted.
“They find things to keep people occupied and entertained.” from the report
Dehydration risks
seriousStaff did not always have clear guidance about how much fluid people at risk of dehydration should receive. One person's low fluid intake continued, but records did not show what further action had been taken.
“Staff were not always provided with sufficient and clear guidance when people were assessed as being at risk of dehydration.” from the report
Risk management
seriousNot all risks were considered fully. For example, the possible increased bleeding risk from an anticoagulant had not been included in guidance for a person at risk of falls.
“Risks to ensure all people's safety, were not always considered or monitored effectively.” from the report
Care records
needs fixingThe manager's monitoring system could not always be relied on because staff did not consistently record people's fluid intake. The report says records needed further improvement.
“staff sometimes forgot to update the daily records to accurately reflect how much fluid people had consumed.” from the report
Infection control practice
seriousTwo senior staff members were seen wearing face masks incorrectly. The manager acted immediately when this was raised.
“They were observed not adhering to guidance when wearing face masks.” from the report
Inconsistent care guidance
needs fixingInstructions for staff were not always equally detailed. Guidance about diabetes was more complete for one person than for another, which could lead to inconsistent care.
“At this inspection, staff were sometimes provided with inconsistent guidance about people's care and support needs.” from the report
- 01How do you now calculate and record the daily fluid allowance for each person at risk of dehydration?
- 02What checks make sure low fluid intake leads to prompt action and accurate records?
- 03How do you identify risks linked to medicines, such as increased bleeding risk after a fall?
- 04What checks confirm that all staff, including senior staff, follow current infection prevention and control guidance?
- 05How have you made sure care guidance is complete and consistent for people with conditions such as diabetes?
This was an announced focused inspection covering Safe, Responsive and Well-led; Effective and Caring were not looked at and their previous ratings carried over into the overall rating. This explanation was written from the published report of 4 September 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, May 2020
Rated Requires Improvement and remains in special measures; the home was Inadequate for being well-led, with serious concerns about safety, medicines, nutrition and personalised care.
This was an unannounced follow-up inspection after the home was previously rated Inadequate. Inspectors spoke with people, a relative and staff, observed care, and checked care, medicine, staff and management records.
Some things had improved. There were enough staff, recruitment checks were completed, staff supported people to move safely, and people said staff were kind. Staff also helped people access health services and managed complaints.
However, inspectors found continued risks. Falls, medicines, infection control, food, drinks and records were not always managed safely. Some people did not receive personalised activities or suitable information, and privacy and dignity were not always protected.
The overall rating improved from Inadequate to Requires Improvement, but all five questions were rated Requires Improvement except Well-led, which remained Inadequate. The home remained in special measures because it had been rated Inadequate in a key question at two consecutive comprehensive inspections.
Enough staff
Inspectors found enough staff to meet people's needs, and people did not have to wait longer than expected for help.
“There were enough staff on duty to support people with their needs.” from the report
Safer moving support
Staff had improved their skills in helping people move and were observed using suitable techniques.
“We observed staff using appropriate manual movement techniques and care plans provided clear guidance for staff.” from the report
Kind staff
People and relatives generally said staff were kind and caring. Staff appeared to know people's histories and needs well.
“People said that staff were kind and caring.” from the report
Health care access
Staff worked with health and social care professionals and supported people with appointments and treatment.
“Records confirmed that staff sought advice from appropriate health and social care professionals when needed, including the GP, district nurse and social workers.” from the report
Complaint handling
People knew how to complain, and complaints had been investigated and answered in a timely way.
“When people raised complaints, these had been investigated and responded to in a timely way.” from the report
Falls and medicines
seriousCare plans were not always updated after falls. Some medicines were given late or recorded inaccurately, and not all staff who might need to give medicines had been assessed as competent.
“The provider could not be assured that medicines were always administered safely by competent staff and this put people at risk.” from the report
Food and choking risks
seriousStaff did not consistently understand or follow a person's modified diet. Food and fluid records were also incomplete, making it difficult to monitor malnutrition and dehydration risks.
“This was not in line with guidance for the IDDSI level 6 diet and put the person at risk of choking.” from the report
Limited meaningful activity
needs fixingPeople said they were bored, and organised activities did not consistently reflect their individual interests. One person's legal conditions about activities and community outings were not met.
“People told us they did not have enough to do and were bored.” from the report
Privacy and dignity
needs fixingSome medicines were given at the dining table in front of other people. Staff also did not always notice when people needed help with food or personal comfort.
“Staff administered medicines, including applying eye drops and eye ointment to people at the meal table in front of others.” from the report
- 01How are medicines now given at the prescribed times, recorded accurately and administered only by staff whose competence has been checked?
- 02How do you identify and respond to falls, weight loss, poor food intake and dehydration?
- 03How will you make sure modified diets are clearly recorded and followed by care staff and kitchen staff?
- 04What personalised activities and community outings are available for each person, including people with dementia?
- 05How do your current audits check that incidents, care records and risk assessments are accurate and acted on?
This was an unannounced follow-up inspection that considered all five key questions and followed action from the previous inspection. This explanation was written from the published report of 29 May 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Edward House
5 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- September 2020Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- May 2020Requires improvementup from InadequateSafe: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- December 2019Inadequatedown from Requires improvementSafe: InadequateWell-led: Inadequate
- December 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- November 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 19 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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