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.
- Safe?
- Good
- Inspectors found that risks, medicines, staffing, safeguarding and infection control were managed safely. This area had improved from Requires Improvement at the previous inspection.
- Effective?
- Good
- This area was not looked at during this focused inspection, so no new rating was given.
- Caring?
- Good
- This area was not looked at during this focused inspection, so no new rating was given.
- Responsive?
- Good
- This area was not looked at during this focused inspection, so no new rating was given.
- Well-led?
- Requires improvement
- The home had improved its quality checks, but monitoring was not yet consistently effective. Inspectors found gaps in behaviour incident and medicines records, and said provider oversight needed to become established.
What inspectors found, August 2021
Edward House is rated Good overall; inspectors found safer care, but leadership and quality checks still required improvement.
This was an unannounced focused inspection on 5 and 8 July 2021. Two inspectors observed care, checked the home, reviewed records and spoke with staff, relatives and health professionals. They looked only at Safe and Well-led.
Inspectors found improvements in managing risks linked to behaviour, epilepsy and choking. Medicines were safer, staffing levels met people's needs, and infection control arrangements were in place. The Safe rating was Good.
The home had improved its monitoring systems, but these were not yet fully reliable. Some behaviour incident and medicines records had gaps, and provider-level oversight had been limited at times. Well-led remained Requires Improvement.
The previous overall rating was Requires Improvement, with two breaches. Inspectors found enough improvement for the home to be no longer in breach, and the overall rating changed to Good.
Safer risk management
Guidance and staff training had improved for epilepsy, eating and drinking, behaviour and emergencies. Inspectors found that people were protected from avoidable harm.
“People's epilepsy was managed safely. Improvements had been made to the guidance available to staff in relation to managing risk associated with epilepsy.” from the report
Enough suitable staff
Staffing levels and skills were judged sufficient for people's needs. Agency staff were inducted and allocated to people whose routines they knew.
“There were enough staff with the right skills and experience to meet people's needs.” from the report
Medicines improved
Medicines storage, staff training and competency checks had improved. Guidance for medicines used when needed, including emergency seizure medicines, was kept updated.
“The provider had taken action to improve medicines safety. This included improvements in medicine storage, relevant staff training and competency checks.” from the report
Caring support
Staff showed a caring, person-centred approach and understood people's needs and behaviour triggers. People's independence, interests and access to the community were being supported.
“Staff demonstrated a caring approach when supporting people. Staff were aware of the support people needed, people's behaviour triggers and how to provide care in a person-centred way.” from the report
Infection control
Inspectors were assured that the home had arrangements to prevent and manage infections, including safe use of protective equipment and support for visits.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Incomplete monitoring records
needs fixingThe monthly behaviour incident analysis was not always completed. Some behaviour incident and medicines records had not been checked to make sure staff followed recording procedures.
“There were some gaps in behaviour incident and medicine records which had not been reviewed to ensure staff always followed the provider's recording policies.” from the report
Provider oversight
needs fixingSupport and oversight from the provider had sometimes been limited because of changes in senior management. Inspectors said more time was needed for this oversight to become established.
“Support and oversight at provider level had been limited at times due to changes in the senior management team.” from the report
- 01How do you now check that behaviour incidents are analysed every month?
- 02What checks make sure medicines records are complete and accurate?
- 03Who provides oversight of the home, and how often do they review its quality and safety?
- 04What improvements have been made since this inspection to make provider oversight consistent?
- 05What are the current ratings for Effective, Caring and Responsive, which were not assessed in this inspection?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 25 August 2021 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, November 2020
Rated Requires Improvement; inspectors found epilepsy medicines and management checks were not always safe.
Inspectors visited the home without notice on 1 and 5 October 2020. They spoke with people, staff, relatives and health professionals. They observed care and checked care, medicine, staffing and management records.
They found enough staff and a clean home. People had opportunities to go out, and staff managed anxiety-related behaviours well. Infection control arrangements for COVID-19 were also effective.
However, some people with epilepsy were not always given medicines as prescribed. Seizure records and incident records had not been reviewed quickly enough. This meant there was a risk that staff might not follow emergency guidance safely.
The overall rating fell from Good at the previous inspection to Requires Improvement. Safe and Well-led were both rated Requires Improvement. The inspection only assessed these two areas.
Enough staff
Inspectors found enough staff to meet people's needs and wishes. Staffing could be adjusted to respond to risks and planned activities.
“There were enough staff on duty to meet people's needs and wishes.” from the report
Clean and hygienic
The home was clean and fresh. Staff followed COVID-19 guidance, including using protective equipment and enhanced cleaning.
“At this inspection the home was clean and smelled fresh.” from the report
Support with anxiety
People had positive behaviour support plans, which helped staff manage anxiety-related behaviours safely and proactively.
“Other risks, such as in relation to people's anxiety related behaviours, were managed safely.” from the report
Safe recruitment
Records showed that staff had been recruited safely and had suitable skills and experience.
“Records showed staff had been recruited in a safe way and in line with the provider's policies and procedures.” from the report
Epilepsy medicines
seriousOne person's increased epilepsy medicine dose was not provided promptly after a hospital stay. Emergency seizure instructions were also difficult to follow, and two records did not make clear whether the correct protocol had been used.
“One person's dose of epilepsy medicine had been increased during a hospital admission. Following their discharge to Edward House, action had not been taken to ensure the person received their increased dose in a timely manner.” from the report
Incident records not reviewed promptly
needs fixingIncident, accident and seizure records were not always checked in good time. This reduced the provider's ability to identify new risks and learn from what had happened.
“Incident, accident and seizure records had not been reviewed in a timely way to ensure care had been delivered safely and to ensure any new risks could be identified.” from the report
Weak management checks
seriousThe provider's audits had identified problems, but agreed improvement work was still incomplete by the inspection. Inspectors said opportunities to reduce risks and learn from incidents had been missed.
“The provider's quality assurance systems were not always operated effectively to ensure improvements needed to maintain safety of the service were actioned in a timely way.” from the report
Inconsistent leadership
needs fixingThere had been no registered manager since November 2019. Staff and external professionals lacked confidence in the new manager's leadership, and the manager left after the inspection.
“There had not been a registered manager at Edward House since November 2019.” from the report
- 01What has changed to make sure every person with epilepsy receives the correct medicine dose without delay?
- 02How are staff being checked on when to give emergency seizure medicine and when to call 999?
- 03Who now reviews seizure, accident and incident records, and how quickly are risks acted on?
- 04Who is currently responsible for the home's management and quality checks?
- 05What progress has been made on the action plan requested by CQC?
This began as a targeted inspection about epilepsy concerns and became a focused inspection of Safe and Well-led; Effective, Caring and Responsive were not assessed. This explanation was written from the published report of 4 November 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
7 rated inspections over 6 years: the service has held its Good rating throughout.
- August 2021Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2020Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- February 2020Goodstayed GoodSafe: GoodWell-led: Requires improvement
- January 2019Goodup from Requires improvementSafe: GoodWell-led: Good
- December 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2017Inadequatedown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- October 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- October 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- March 2011
Registered with the Care Quality Commission on 1 March 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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