This inspection took place on 18 and 20 July 2016 and was unannounced.

Edgeley House provides personal and nursing care for up to 60 people. At this inspection 30 people were living there some of whom were living with dementia.

A manager was in post and present during our inspection. The manager was newly appointed and commenced work at Edgeley House approximately eight weeks prior to this inspection. We confirmed that they had submitted appropriate applications to become the registered manager. 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 the last inspection on 16 and 17 December 2015, we identified four areas where the provider was not meeting the requirements of the law. The registered provider did not have an effective quality assurance monitoring system in place to ensure people received a safe and effective service. People were not involved the planning of their own care and were not treated with dignity and respect. There were not enough staff to make sure people’s needs were met and they were supported with their hobbies and interests.

The provider sent us an action plan in April 2016 telling us what they would do to make improvements and meet legal requirements in relation to the law. We found at this inspection the provider had taken the necessary measures to ensure the quality of care people experienced had improved.

People were involved in decisions about their day to day care and people had care plans which were mostly individual to them. Care plans contained personal likes, dislikes and personal histories and were either recently reviewed or in the process of being reviewed. Staff had a good knowledge of the people they supported. People and staff had positive relationships. People took part in activities they liked and found stimulating.

When people could not make decisions for themselves staff understood the steps they needed to follow to ensure their rights were upheld. People were involved in the day to day running of their home and attended regular resident meetings.

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. Risks associated with people’s care had been assessed and actions put in place to minimise the risk of harm.

There were enough staff to support people and to meet their needs. The provider had systems in place to adapt to the changing needs of people and to make provision for additional staffing when required. Before staff could start work the provider undertook checks to ensure they were safe to work with people.

People received their medicine from staff who were trained to safely administer these and who made sure they had their medicine when they needed it. The provider undertook checks to ensure staff followed safe practices when helping people with their medicines.

Staff had the skills and knowledge to meet people’s needs. Staff attended training that was relevant to the people they supported. Staff were supported by the provider and the manager who promoted an open and transparent culture.

Staff made sure people were involved in their own day to day care and information was given to them in a way people could understand. People’s independence was encouraged and staff respected their privacy and dignity.

People had a choice of food to eat and were prompted to maintain a healthy balanced diet. People’s routine health needs were looked after and people had access to healthcare when they needed it.

People and staff felt able to express their views and felt their opinions mattered. The provider and manager undertook regular quality checks in order to drive improvements. The provider engaged peopl

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

In this report the name Gillian Ann Bratt appears, who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still identified as the registered manager on our register at the time.

This is a summary of what we found:

Is the service safe?

We had received concerns from the Clinical Commissioning Group (CCG) about the lack of wash areas to meet people’s needs. On the day of our inspection the nurse in charge confirmed one shower room was available for 36 people. This meant there were insufficient wash areas available for people to access. The CCG also raised concerns about the cleanliness and hygiene standards within the home. We found that some areas of the home were unclean but this was also compromised by refurbishment taking place on the day of our inspection.

We saw that a number of people required the use of a wheelchair. We observed that foot plates were either missing or not used. We observed a care staff manoeuvring a wheelchair without foot plates and saw that the person’s feet remained in the same position whilst the wheelchair was turned. This placed the person at risk of discomfort and injury.

Discussions with the acting manager confirmed that a number of overseas nurses had been appointed and their first language was not English. We heard two nurses not speaking in English. One person who used the service told us, “I find this very frustrating.” The fire safety officer raised concerns that one staff member had very little understanding of the home’s evacuation procedure because of their poor understanding of the English language. This meant that people who used the service may not be able to communicate with all the staff effectively and this could compromise their wellbeing and safety.

On the day of the inspection a major refurbishment of the premises was taking place. Whilst walking around the home we saw a number of items that obstructed the corridors. This had an impact on the evacuation process in the event of a fire and was also a trip hazard.

During the inspection we saw that a number of fire doors were wedged open with furnishings. These practices could also compromise people’s safety in the event of a fire. We shared these concerns with the fire and rescue department who have carried out their own inspection of the premises.

Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted policies and procedures were in place. The area manager said that this would be kept under review.

Is the service effective?

One person who used the service said, “It depends on what cook is on duty to the variety of foods available.” Another person told us, “The food is very good.” Discussions with people who used the service, staff and the records we looked at confirmed that people’s nutritional needs were met.

Some people required assistance with eating and drinking. We saw that one person was not assisted with their meal in a dignified manner. However, we also observed some good practices. For example, staff sat with a person and assisted them in a kind and gentle manner.

Records were in place to monitor people’s body weight and where necessary referrals were made to a dietician or speech and language therapist (SALT) to provide additional support.

Is the service caring?

One person who used the service told us, “The staff do look after me, they do their best.” Another person said, “Its good living here.” We found that the environment was unsuitable to ensure people’s privacy. For example we saw that a number of toilet doors were not fitted with a privacy lock and this was acknowledged by the acting manager. One person who used the service said, “I call them the second class toilets and I don’t use them. I go to the other side of the home where the toilets have a lock.” The absence of privacy locks meant that people’s privacy would not be entirely maintained.

We saw a number of people were left in their wheelchairs at meal times and one person was asleep in their wheelchair. This could compromise people’s comfort and safety. The acting manager acknowledged that this practice was unacceptable and said that people should be transferred into suitable seating.

Is the service responsive?

One person who used the service told us that they had written a letter of complaint to the area manager. They confirmed that the area manager had visited them to discuss their complaint but this had not been responded to in writing They said that no action had been taken to resolve their complaint. The area manager said because they had discussed the complaint with the person they did not respond in writing. This meant that people could not be confident that their complaints would be addressed appropriately.

Is the service well-led?

The registered manager had recently resigned. A new acting manager had been appointed and on the day of the inspection the acting manager had been in post for two weeks. The acting manager was aware of some of the shortfalls we had identified and was in the process of developing an action plan to address these.

The people we spoke with told us that they were impressed that the acting manager had made the effort to introduce them self. Two people showed us a letter that they had received from the acting manager inviting them to a meeting.

Audits were in place to monitor accidents and incidents to establish trends. This enabled the provider to take the appropriate action to reduce further reoccurrence to ensure people's welfare.

The acting manager said that an audit was in place for the management of medicines and we saw this This ensured that people received their prescribed treatment.

We talked with some of the people who lived in this home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff always considered their privacy and treated them with respect.

People who lived in the home told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff talked of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were mostly available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “The staff are very good” and another said, “The staff are lovely”.

We talked with people who lived in the home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “Very helpful staff” and another said, “The staff are very good”.

The provider had developed a system whereby they could monitor how well the home was meeting the needs of the people who live there.

We saw maintenance, repair and improvement work being carried out in communal and private areas within the home. This involved such things as new flooring, decorating and installing new doors in the corridors.

We did not talk about the outcome groups that this inspection focused on but we talked to a number of people about their experiences in the home.

They said such things as "Yes; very nice" and of the staff they said "Excellent; always chatting to me".

We visited the home on 3 July 2012.

There were a number of the people who lived in this home who were unable to talk to us clearly about their experiences. To gain an insight into what they experienced we looked at the records that the home had developed about five of those people. We found that this information was accurate enabling us to focus our questions in a way that would allow people to understand what we were asking and therefore express what they thought.

People who lived in the home, as well as some of their relatives, told us that the staff had explained to them what care and treatment they would be receiving.

Some of the people who were living in the home said that there were regular meetings of all of the people who lived there where they can raise and discuss any issues that were affecting the care that they were receiving.

People told us that they had a range of meals that they could choose from and that it was well prepared and presented. One person said, “The food is lovely” and one person’s relatives told us, “They keep trying to find stuff that *** will eat.”

We were also told that there was a range of activities available for people to take part in should they wish to.

We also talked to a number of people who were visiting friends or relatives. They told us that the home had always made them feel welcome.

The people who lived in this home they told us that they felt able to raise any issues about which they had concerns with the manager or one of the staff.

Those people also told us that they felt safe living in this home. They were very complimentary about the people who work in the home saying such things as, “They all work very hard. They are always on the go”.

We visited Edgeley House to check on the care and welfare of people living at the home. This was in response to recent concerns about how people were being looked after. Althouh we found the home to be compliant with the outcomes that we reviewed during our visit, we did not look at the outcome relating to records. We had previously made a compliance action against this outcome and therefore we could not say that the home was fully compliant. We will be reviewing this outcome in the future.

During our visit we spoke with eight people who used the service, five staff, a relative and two senior managers. Most people living at the home were unable to verbally communicate their views and experiences. We therefore spent some time in one of the lounges to carry out a short period of observation of activity. The general mood of people in the lounge at this time was calm and we observed staff interact with people in a relaxed and unhurried manner. Staff were seen to be kind and courteous.

People who spoke with us said that they were well looked after. One person told us that they were comfortable and everyone we spoke with said that they felt safe. We were told by one person who lived at the home that they had been involved and consulted in the development of their care plan and that this meant that they could now have their needs met in a way that they preferred. Staff told us that care plans were currently being updated with their involvement. We saw that care plans were up to date and reflected people's needs. Staff told us that this information was “useful”.

On the day of our visit we saw that staff were busy attending to people's personal care needs throughout the home. People shared mixed experiences of activities within the home. One person said that there were activities on offer but that they chose not to take part. One person told us that there was nothing to do. This was also reflected in conversations with a visitor. We saw that one person who was unable to get out of their bed, had no visual or auditory stimulation. Staff told us that they popped in to see the person when they could. The regional and area manager fully supported our findings and told us that that they had identified that improvements were needed in this area. They also explained reasons why activities were not being carried out regularly. They had an action plan to address this issue and we will monitor this.

People told us that overall staff were very good. People said that some staff provided “excellent” care. One person told us that some staff were not well trained and did not attend to the “little details” that made a difference to people. We saw that staff were task focussed and therefore were unable to offer positive stimulation and structure for all of the people living at the Edgeley House. The area manager and the regional manager had also identified this as an area where improvement was required. They had identified the need for “back to basics” training. Staff who spoke with us on the day of our visit demonstrated a good understanding or people’s needs although our observations and discussions identified that improvements could be made to deliver better quality care.

People were protected because staff were confident to recognise and report abuse. The home had implemented changes in response to recent safeguarding investigations to make the home a better and safer place to live.

This inspection was unannounced and took place on 16 and 17 December 2015.

Edgeley House Care Home provides nursing and personal care for up to 60 older people and people living with dementia.  On the days of our inspection 38 people were living there.

The home has not had a registered manager in post since October 2015.

 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 previous inspection in May 2014, the provider was in breach of the regulation relating to the suitability of the premises.  We asked the provider to take action to make improvements to ensure the safety of the premises.  The provider sent us an action plan July 2014, telling us what they would do to make improvements.  We found at this inspection the provider had taken the necessary measures to ensure the premises were safe and suitable to meet people’s needs.

Staff were not always nearby to support people when needed and this placed them at risk.  Although people felt safe living in the home and staff knew how to protect them from potential harm the practices we saw did not always demonstrate this.  Staff told us they had access to risk assessments that told

them how to support people safely and equipment required to assist them.  Accidents and incidents were recorded and action taken to avoid them happening again.  People’s medicines were managed safely and they received them when needed.  Medicines were stored appropriately and records were maintained to show when medicines had been given to people.

We saw that staff were not always sympathetic to people’s needs and they were not always supported.  Practices within the home did not ensure everyone was involved in their care planning so they received a service the way they liked.  Staff did not respect people’s right to privacy and dignity.

People were not always involved in the assessment of their needs and the provider had not explored people’s interests and hobbies.  There was limited stimulation provided and people told us they were bored.  People were unaware of the provider’s complaint procedure but said they would share their concerns with staff.  We found that complaints were listened to and managed appropriately.

The provider did not have a registered manager and people were unaware of who was running the home.  There was no clear leadership and staff felt unsupported.  We found that the provider’s quality assurance monitoring audit systems were not robust to ensure people received a safe and effective service.

Staff  had access to training to ensure they had the skills to care for people.  Staff did not receive regular supervision and they felt unsupported by the management team.  We found that not all staff were aware of the principles of the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguard (DoLS) and this placed people at risk of their human rights not being protected.

People had a choice of meals  but we found that where people required support with their meals this was not always provided. People had access to other healthcare services to ensure their healthcare needs were met.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. 

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service.  This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.  This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.  Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service.  This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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