This inspection took place on 18 and 19 September 2018 and was unannounced. Edgecumbe Lodge is registered to provide accommodation and personal care for up to 21 people. At the time of our visit there were 19 people living at the service.

There was a registered manager in post. 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 July 2017 we rated the service overall as Requires Improvement. At that inspection we found some breaches in our regulation had been fully met, some had been partially met and we needed to be satisfied that the improvements made would be sustained.

The registered manager told us, “Our focus has been around sustaining and continuously improving the quality of the service we provide in a safe environment, this specifically relates to maintaining infection control measures and safe practices, maintaining the building, premises/equipment and maintaining compliance checks and audits. One new initiative has been the managers walk around which is completed weekly with the aim of identifying areas of improvement before things fall back, this is a complimentary process to the service audit around the environment”.

At the time of the inspection the service had improved and people received a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm. People were supported to take risks and promote their independence. Risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Medicines were well managed and people received their medicines as prescribed. Infection control policy and procedures were followed.

At the time of the inspection the service had improved and people received a service that was effective. Staff received regular supervision and the training needed to meet people’s needs. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice.

We were introduced to people throughout our visit and they welcomed us. They were relaxed, comfortable and confident in their home. The feedback we received from them was positive. Those people who used the service expressed satisfaction and spoke highly of all staff. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner.

The service had sustained previous improvements and staff were responsive to people’s needs. People received person centred care and support. Staff monitored and responded to changes in people’s needs. They were knowledgeable about people's lives before they started using the service. Improvements were required to enhance this knowledge so that their life experiences remained meaningful.

At the time of the inspection the service had improved and people received a service that was well led. The registered manager and staff team maintained a clear focus on continually seeking to improve the service people received. Quality assurance systems were in place and based upon regular, scheduled audits which identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.

Further information is in the detailed fin

This inspection took place on 4 and 22 July 2017 and was unannounced. Edgecumbe Lodge is registered to provide accommodation for up to 21 people. At the time of our visit there were 21 people living at the service.

There was a registered manager in post. 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 2016 we rated the service overall as Requires Improvement. At that inspection we found breaches of Regulations 12, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following that inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of those regulations. At this inspection we saw the provider had taken action as identified in their action plan. As a result improvements had been made. However although some breaches had been fully met, some had only been partially met and we needed to be satisfied that the improvements made would be sustained.

As a result of this inspection the service remains rated overall as Requires Improvement.

The appointment of the registered manager had helped rectify previous poor management of the service. An increase in the provider’s oversight meant that a significant number of improvements had been made to help ensure that people were safe and received quality care.

Improvements had been made to help ensure people were protected from the risk of cross infection. This was because appropriate guidance had been followed. People were now cared for in a clean, hygienic environment. Improvements were still required to ensure infection control audits were completed regularly in order to ensure good practice was sustained.

Previously there were some areas where safety had been compromised because of the environment and poor maintenance. Although improvements had been made further improvements were required. Some maintenance checks regarding the safety of the premises had lapsed. Personal evacuation plans in the event of an emergency, had been reviewed and updated to protect people in the event of a fire.

At our previous inspection we found monitoring of the quality of the service had lapsed; audits had not been consistently applied and were not robust enough to ensure quality and safety. In addition the provider lacked knowledge and understanding about their legal obligations. Quality audits had now improved and provided clear accounts of monitoring of the service provision, they helped identify where further improvements were required. Some audits had not been completed but this had been rectified by the end of this inspection. We (CQC) need to be satisfied that these will be sustained in the future.

Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Medicines were managed safely and staff followed the provider’s policy and procedures.

The provider’s recruitment policy and practices helped to ensure that suitable staff were employed. The manager and staff were able to demonstrate there were sufficient numbers of staff with a complementary skill mix on each shift.

People were helped to exercise choice and control over their lives wherever possible. Where people lacked capacity to make decisions best interest decisions had been made. The Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People received a varied nutritious diet, suited to individual preferences and requirements. Mealtimes were flexible and taken in the setting people chose. People enjoyed recei

This inspection took place on 7 and 8 June 2016 and was unannounced. There were no concerns at the last inspection of May 2014. Edgecumbe Lodge is registered to provide accommodation for up to 21 older people. At the time of our visit there were 20 people living at the service.

The registered manager had recently left the service. The Directors were actively recruiting at the time of out 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.

Previous poor management of the service and the lack of the provider’s oversight meant that a significant number of improvements were required to ensure that people were kept safe. People were not protected from the risk of cross infection. This was because appropriate guidance had not been followed. People were not cared for in a clean, hygienic environment. People had personal evacuation plans in the event of an emergency, but they were out of date and did not reflect how to protect people if there was a fire. There were some areas where safety was compromised because of the environment.

The arrangements in place to ensure that the service was well led were unsatisfactory. Monitoring the quality of the service had lapsed; audits had not been consistently applied and were not robust enough to ensure quality and safety. People’s views and experiences were not sought through quality assurance systems. The provider lacked knowledge and understanding about their legal obligations.

The provider and Directors had identified a deterioration in the service provision earlier this year and it was acknowledged that significant improvements had been made. This included promoting a person centred approach to care, improved effective training and increased supervision and support for staff. Staff were keen to share their views about the service and what it was like to work there. All staff were feeling positive and supported and welcomed all the new initiatives being introduced. One relative said, “Despite recent problems I do feel that the home has that family feeling and staff care about the people they support”.

People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions best interest decisions had been made. The Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People received a varied nutritious diet, suited to individual preferences and requirements. Mealtimes were flexible and taken in a setting where people chose. Staff took action when people required access to community services and expert treatment or advice.

People enjoyed receiving visitors and had made friends with people they lived with. They were relaxed in each other’s company. Staff had a good awareness of individuals' needs and treated people kindly. Staff were knowledgeable about everyone they supported and it was clear they had built up relationships based on trust and respect for each other.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We looked at five standards during this inspection and set out to answer these key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives and with staff, and looking at records.

Is the service safe?

People told us that they felt safe living at the home. Risks relating to people's health and care needs were being identified. People's medication was kept securely and being managed safely.

Facilities and equipment in the home were being regularly checked to ensure they were safe and working correctly. Aids were being used to assist people with their mobility; staff had received training so that they knew how to use this safely with people.

Is the service effective?

People told us that the home was meeting their needs. Individual care plans had been produced which set out the support they would receive. This provided guidance for staff, who assisted people in ways which helped them to maintain their independence.

People were supported with seeing healthcare professionals to ensure that their individual needs were met. Staff told us that people received good support from the community nurses who came to the home.

Is the service caring?

The relationships we observed between staff and the people who used the service appeared to be friendly and positive. Staff talked to people in a respectful way and took time to explain what they were doing, for example when administering medicines.

Relatives we met with said they were made to feel welcome during their visits. One relative told us that people looked well supported with their personal care when they visited.

Is the service responsive?

People were asked about their choice of meals, which were prepared in ways which met people's individual needs.

Surveys were being used to gain the views of the people who used the service, their relatives and staff. The feedback provided information about what was working well and how the service could be improved.

Is the service well-led?

The service has a manager who is registered with the Commission. Support was provided by a deputy manager who had specific areas of responsibility. Some staff were in the role of seniors; they took the lead on each shift and were available to support the care workers as needed. This showed that there was a structure in place for overseeing the day to day running of the home to make sure that the appropriate procedures were being followed.

People we spoke with told us they were supported to be independent and they were given choice. People said they were always asked if they needed help. We observed that staff spoke to people kindly and respectfully in a way that was appropriate. We saw that staff were relaxed and patient with people.

People had their care needs assessed and planned and staff told us that there was good communication within the team if people's needs changed. A relative told us they thought the standard of care was good and that they were kept informed of any concerns. The people we spoke with were satisfied with the care they received.

Professionals from other services told us that staff at the home were cooperative and knowledeable about the people they cared for.

The home was clean and free of odours. Feedback from people and their relatives indicated they were satisfied with the cleanliness of the home. The provider had a system in place to manage the risk of infection and their was guidance for staff on maintaining a clean environment.

The provider carried out appropriate checks before people were employed at the home.

The provider had an effective system to monitor the quality of the service, which included seeking the views of people living in the home, their relatives and staff. There was an effective complaints system and people and their relatives were confident they would be listened to and action taken

We carried out this inspection to check if improvements had been made following our inspection of February 2012. We found that following the appointment of a new registered manager, significant improvements had been made.

At the inspection of February 2012 people told us they were happy with the care they received from staff at the home. Concerns were raised at our previous inspection with regard to record keeping. Standards of reporting to external agencies was poor. The condition of the premises and furniture was poor, risks and hazards in the environment had not been identified or addressed. People could not be sure that there were enough staff who were sufficiently supported and trained. The provider did not have effective systems in place to monitor the quality and safety of the service.

At our inspection of 1 October 2012 we found that care records now recorded people's care needs, were regularly reviewed and that consent was routinely obtained from people living at the home. Staff had received training in safeguarding vulnerable adults and the Mental Capacity Act 2005. The home was being refurbished and the grounds landscaped.

The numbers of staff had been increased with separate staff to carry out domestic and kitchen duties.

The provider had not yet developed effective infection control policies and procedures or quality monitoring systems however, improvements had been made in both these outcome areas.