We inspected the service on 22 June 2017. The inspection was unannounced. Eden Lodge

Residential Care Home provides accommodation for up to 60 older people. On the day of our inspection 19 people were using the service. This was because the provider is only currently using one section of the service.

When we inspected the service on 6 April 2016 we found there were breaches of regulation and improvements were required in a number of areas in the standard of care provided. This included improvements to how people were protected against the risk of avoidable harm, their nutritional and hydration needs were met and how risks were assessed and safe care provided. This also included improvements with staff’s competency and knowledge, with the premises and equipment and how medicines were managed. There were also improvements needed in relation to the way the registered provider monitored and assessed the service to identify and act on any improvements needed. We told the provider they must send us a written plan setting out how they would make the improvements and by when. The provider sent us an action plan and told us they would make the improvements.

We inspected the service again on 2 August 2016 and reviewed what improvements had been made in relation to how risks were managed and how the provider was monitoring quality and safety. At this inspection we found some improvements had been made but further improvements were still required. The provider sent us a further action plan and told us what additional improvements they would make.

During this comprehensive inspection we looked at whether the provider now met the legal requirements in relation to breaches of regulation we had found in April 2016 and August 2016. We found that the provider had taken action and all the breaches had been met.

People and their relatives told us they felt staff provided safe care and support. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and reviewed to ensure they continued to reflect people’s needs. Risk plans informed staff of the action required to reduce any associated risks to people’s needs. Accidents and incidents were recorded and reported by staff. The registered manager analysed these to ensure appropriate action had been taken to protect people, and to consider if there were any themes or patterns that required further action. Contingency plans were in place to support staff to provide a safe service in the event of an untoward incident affecting the service.

There were sufficient staff to keep people safe and meet their needs. Safe recruitment procedures were in place and followed. Medicines were given to people on time and as prescribed, they were also managed and stored safely following best practice guidance.

People were supported effectively by staff that had received an induction, ongoing training and support.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had received appropriate training and understood the processes in place for ensuring decisions were made in people’s best interests. People and or their relative where appropriate, had given consent to their care and treatment. Some people were living with dementia and experienced periods of anxiety that affected their mood and behaviour. Staff had appropriate information about how to support people during these times.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. Catering staff had received additional training to understand people’s nutritional needs. People were appropriately supported with their eating and drinking needs if required, choices were offered and respected, and independence encou

We carried out an unannounced comprehensive inspection of this service on 6 April 2016. Breaches of legal requirements were found. We issued warning notices to the registered provider for the breach of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe care and treatment and Good governance.

We undertook this focused inspection on 2 August 2016 to confirm that the provider had met the requirements of the warning notices. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eden Lodge Residential Care Home on our website at www.cqc.org.uk.

The inspection was unannounced. Eden Lodge Residential Care Home provides accommodation for up to 60 older people. On the day of our inspection 22 people were using the service. This was because the provider is only currently using one section of the service.

The service had a registered manager in place at the time of our inspection. 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. There was a manager in post and they had submitted an application to register with us.

Although people felt safe in the service, people were not always protected from risks in relation to their care and support and medicines were not always managed safely. Information was shared with the local authority safeguarding vulnerable adult’s team when needed and safe recruitment practices had been implemented.

Governance processes had been implemented and although this was identifying issues and leading to improvements, the issues we found had not all been identified. People felt the registered manager was approachable.

You can see what action we told the provider to take at the back of the full version of the report.

We inspected the service on 6 April 2016. The inspection was unannounced. Eden Lodge

Residential Care Home provides accommodation for up to 60 older people. On the day of our inspection 24 people were using the service. This was because the provider is only currently using one section of the service.

When inspected the service on 14 July 2015 we found there were breaches of regulation and improvements were required to ensure incidents of a safeguarding nature were handled appropriately, people received care and support from adequate numbers of experienced staff and that staff recruitment practices were safe. There were also improvements needed in relation to the way the registered provider monitored and assessed the service to identify and act on any improvements needed. We told the provider they must send us a written plan setting out how they would make the improvements and by when. The provider sent us an action plan and told us they would make the improvements.

During this comprehensive inspection we looked at whether the provider now met the legal requirements in relation to breaches of regulation we had found. We found that although some improvements had been made there were further improvements needed. We also found the service had deteriorated in other areas.

The service did not have a registered manager in place at the time of our inspection. 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. There was a manager in post and they had submitted an application to register with us.

Although people felt safe in the service, people were not always protected from unauthorised restraint and information of concern was not always being acted on or shared with the local authority. Risks in relation to people’s care were not always planned for appropriately to ensure people received safe care and support. Safe recruitment practices were not always followed and medicines were not managed safely. People were supported by enough staff to ensure they received care and support when they needed it.

People were not supported to eat and drink enough. People were supported to make decisions but there was a lack of understanding of supporting people who lacked the capacity to make certain decisions. People were supported by staff who had received training and supervision. Staff were responding to people’s daily health needs.

There was a lack of consistency in people’s needs being recognised and responded to by staff and in how privacy and dignity was respected. People were supported to make choices about how they spent their day.

People did not have their care and support planned for appropriately and this led to people receiving inconsistent care which was not always safe. People knew how to raise concerns and complaints were responded to appropriately. People were involved in giving their views on how the service was run and felt the management team were approachable.

There was a lack of appropriate governance and risk management framework and this resulted in us finding multiple breaches in regulation and negative outcomes for some people who used the service. You can see what action we told the provider to take at the back of the full version of the report.

We inspected the service on 14 July 2015. The inspection was unannounced. Eden Lodge Residential Care Home is a care home (without nursing) which provides long term and respite care services. The home is registered for accommodation up to a maximum of 60 people. On the day of our inspection 24 people were using the service. This was because the provider is only currently using one section of the service.

We carried out an unannounced comprehensive inspection of this service on 22 July 2014. A breach of legal requirement was found in relation to the Mental Capacity Act 2005 (MCA) and we asked the provider to make improvements. After our unannounced comprehensive inspection we also received some concerns in relation to the service.

We undertook this focused inspection to confirm that the provider now met legal requirements and to look at the concerns we had received. This report only covers our findings in relation to those requirements and what we found in relation to the concerns raised. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Eden Lodge Residential Care Home on our website at www.cqc.org.uk

We found the manager had made the required improvements in relation to completing appropriate assessments where people lacked the capacity to make certain decisions.

However we found that incidents in the service were not always being responded to appropriately and there were not always enough staff to support people with their care and support and staff were not always being recruited safely.

The systems in place to monitor the quality and safety of the service were not effective and this had resulted in fire safety systems lapsing.

We carried out this inspection under Section 60 of the Health and Social Care Act 2012 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2012 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

At our last inspection in June 2013 we found that the care provider was meeting the essential standards of quality and safety in all five outcomes we inspected against.  

Eden Lodge Residential Care Home provides accommodation and personal care for up to 60 people. On the day of our inspection 22 people were using the service. The registered provider told us this was because they had closed a section of the home.

The home did not have a registered manager and has not had one since July 2011. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Staff had an understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs). We saw information that best interest assessments had been completed for some people who lacked capacity.  However the provider was not always making sure people were free from restrictions. We found the location was not meeting the requirements of the Deprivation of Liberty Safeguards.

The acting manager made safeguarding vulnerable adult’s referrals when needed and staff knew how to respond to incidents if the acting manager was not in the home. People were not always protected under the Mental Capacity Act 2005. This meant people were safeguarded from the risk of abuse but where people lacked capacity, they were not always supported with decisions appropriately.

Staff had the knowledge and skills to care for people safely.  Referrals were made to health care professionals for additional support or any required intervention when needed. This meant people would receive support from the appropriate people when their needs changed.

We observed people were treated with dignity and respect. People who used  the service told us they felt staff were always kind and respectful to them.

There were systems in place to monitor the quality of the service and to involve people in giving their views of how the service was ran. Audits had been completed that resulted in the acting manager implementing action plans to improve the service. This meant there were effective systems in place to monitor and improve the service.

We found there was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2010 at Eden Lodge Residential Care Home. People’s capacity to make decisions was not always assessed and the provider was not always making sure people were free from restrictions.

You can see what action we told the provider to take at the back of the full version of the report.

We saw that relatives of people who used the service had been involved in providing information about their relatives and the completion of their care plans.

A relative told us, “Staff ask my relative for consent; they don’t just do things or tell my relative to do things.”

One person who used the service told us, “I’m very happy here. My family and I made the right choice.”

We saw that people’s care plans contained detailed information about themselves and their preferences. We saw that care plans and risk assessments had been reviewed on a regular basis and information had been updated following reviews.

An external health care professional told us, “I’ve seen a steady improvement.”

One person who used the service told us, “I feel safe here; I’ve got no worries.”

All of the staff we spoke with were able to tell us the procedures in place to make a safeguarding referral. They told us they would report concerns to the manager and felt their concerns would be dealt with appropriately.

One relative told us, “If I had a complaint I’d raise it with the manager but I’ve not had to yet. I haven’t attended any relatives meetings yet but the manager is always available.”

We noted that meetings had been held regularly with staff and people who used the service. We looked at minutes for meetings and saw that action had been taken to address issues raised at meetings.

We looked at surveys completed by people who used the service, their relatives and health care professionals. The responses were mostly positive.

We saw that audits and risk assessments had been completed appropriately on a monthly basis and actions identified for completion.

We looked at the service’s contract of residency, the service user guide and statement of purpose. The documents provided relevant and appropriate information.

Because most of the people who lived at the home have limited communication, we were unable to ask them about their experiences. We used this visit to specifically look at how medicines are administered and what quality initiatives were used to ensure people are safe in the home.

Most of the people who live at Eden Lodge Residential Care Home would find it difficult to help us understand their views. However we did mange to communicate with some people. One person told us that they liked living at Eden Lodge but some times got depressed due to the levels of noise. Another person told us they felt safe and well looked after. Two other people we spoke with told us they were happy with the quality of food provided.

During our visit we spoke with some people who use services who told us they were happy

with the care and support they received. One person told us: "We are all happy with one

another, and we get along well."

People told us the quality of food was good. One person told us: "The meal I have just

eaten was nice, there was enough." Another person we spoke with told us: "I can have

anything I want to eat." One person who had been given trifle made from jelly told us: I do

not like jelly, I did not get a choice, they just brought this." One person we spoke with told

us: "The staff are okay, they look after me okay."

One person commented, “I have no family and rely on the staff. I can express myself and do most things for myself. I feel that I am given the privacy that I need. Staff will check on me at regular intervals during the day and at night when I am in my bedroom.” They explained, “I am able to express my views and they are taken into account. I try to remain as independent as possible.”

We saw that people who lived at Eden Lodge Residential Care Home often sat in an alcove area off the main corridor of the home and when we asked one person about this, we were told they were, “Just resting their feet or just having a chat.”

We spoke with two people who both told us that they felt safe being at the home.

One person told us, “Staff treat me well.”

Two relatives of people using the service both told us, “I reviewed my relative’s care plan with staff a couple of months ago. I saw the home first before my relative came here.”

We found that care plans were not detailed for each person’s individual likes and dislikes which meant staff may not have sufficient information to provide care to people using information from their care plans.

Staff offered a choice of meals to people and asked them what drinks they preferred with their meals. Staff were busy throughout the lunch period. Staff members mostly responded to people’s requests in a timely manner.

One person, who uses the service, told us, “The home is clean.” One staff member said, “The home is generally clean but I don’t think the cleaners are on duty long enough.”

One staff member said, “I feel rushed to get jobs done,” and the second staff member said, “I have more time to be with people in the afternoons.”

We saw that the acting manager was completing audits on a variety of areas. We saw that visual inspections of the home were regularly carried out.

Two relatives of people using the service were both aware of the complaints system.

We looked at care plan records for people using the service. We saw inconsistent records in all the care plans relating to people’s choices in their care and treatment and the information they were provided about the services they used.