At the last inspection on 27 and 29 March 2017, the service was rated as requires improvement. This comprehensive unannounced inspection was carried out on 26 November 2018. At this inspection, whilst we found that the service had made improvements in activities for people living at the service, improvements continued to be needed in a number of key areas as described below. This is the second time the service has been rated as requires improvement.

The service is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Edensor is registered to support 48 older people, some of whom may be living with dementia. On the date of our inspection, 41 people were being supported by the service.

At the time of inspection there had not been a registered manager at the service for three months. The deputy manager, who had worked at the service for some years had been employed into the manager role and was in the process of submitting an application for registration.

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.

People who were able to speak to us, told us that they were happy living at the service and that they felt supported and cared for by staff. Relatives told us they felt their loved ones were cared for safely.

Staff had received training on safeguarding adults from abuse and understood their responsibilities to prevent people from experiencing harm.

Risks were not always explored in a robust way. Where risk information was gathered, it was not used in a way to inform staff how to best manage and mitigate the risks to people.

The clinical nurse lead and qualified nursing staff managed medicines and medicine audits. However, these audits did not identify concerns we found on the day of inspection. This was mirrored in some safety audits. Whilst safety audits had taken place within correct timescales, checks carried out during this inspection demonstrated that they were not always accurate.

Staff were recruited robustly and safely and extra care had been taken to ensure that those people interviewed could demonstrate the values of the organisation.

The new training coordinator worked with a clear and concise training plan to ensure that staff were up to date with mandatory training. They also had been trained to carry out face to face training in a variety of key areas.

People had access to a variety of choices of food and fluid which were available throughout the day, and were also able to request meals that were not on the menu. Improvements had been made with the meal times and choice. However, this was an area that could continue to be improved, including the meal time experience and the recording of people’s specific nutritional and fluid needs.

We made a recommendation about the meal time experience for people living with dementia.

The provider had made significant improvements in the quality and layout of the service and was in the process of continuing to improve this area. There continued to be issues with cleanliness.

The staff were caring. They knew people well and were sensitive to their needs. People were encouraged to be as independent as possible and staff treated them with dignity and courtesy.

The manager and activity coordinator had worked tirelessly to improve the quality of activities provided to people and demonstrated continuous drive to ensure that all people living at the service had access to various opportunities and experiences. This included some innovative and creative thinking about how to engage external org

This inspection took place on the 27 and 29 March, 2017 and was unannounced.

This service is a nursing and residential home for up to 50 people who have nursing, and physical and mental health needs. At the time of inspection 43 people were living at the service which was set out over a number of areas in the building. The flat, downstairs, and the second and third floor.

There was a registered manager in place at the time of 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.

We found that the service was safe. Good recruitment processes were in place with values based interview questions and all necessary pre-employment checks had been carried out on staff.

Medicines were stored and dispensed safely and people’s physical needs, including nursing interventions were carried out in a timely and safe way.

People with complex and challenging behaviours were cared for by staff that knew them well and who supported them with compassion. However, documentation that was specific to behaviours that challenged needed improving to evidence what people told us about the care they received.

Staff had received training to recognise signs of abuse and knew how to act upon concerns.

Dementia and sensory impairment training was needed for staff working with people living with these disabilities. The consequence of not having this training was witnessed in some of the interactions with staff which needed improvement in order to support people to live well with these difficulties.

Some peoples opportunity for social interaction and stimulation was limited meaning they were at risk of social isolation. The management team acknowledged that additional work was needed on the provision of activities for these people.

People received a good choice of food and could request alternatives at any time. People with specific dietary needs were catered for well.

Staff understood the Mental Capacity Act and the importance of this within their everyday interactions with people living at the service.

Staff were caring and respected peoples dignity, privacy and confidentiality.

Care plans were person centred and easy to navigate through, although some people said they did not get involved in the planning of their care.

Loved ones of people living at the service felt they were listened to and if they had a complaint the management team and staff would put it right.

The new provider and existing management team kept people and their loved ones up to date with changes at the service. They also acted as positive role models in all interactions with people and relatives.

Robust systems were in place to investigate incidents and accidents and disseminate learning from these to the staff team.

Clinical governance processes were good and we saw that these were being appropriately used to monitor and manage the quality of care and any potential risks at the service.