This inspection took place on 21 and 25 September 2017 and was unannounced. Edgemont View Nursing Home is registered to accommodate up to 21 people. At the time of our visit there were 19 people living at the service.

A newly appointed manager had been in post for four weeks at the time of our inspection. They had submitted an application to CQC 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 our last inspection in August 2016 we rated the service overall as Requires Improvement. This was because we found breaches in Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found people were not protected from the risks associated with cross infection, the service was not always well led and improvements were required. Provider visits needed to be more robust in order to support people who used the services. Auditing of the service and facilities was not effective or sufficient. In addition the service was not meeting a condition of their registration where there must be a manager registered with the CQC.

Following the inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of that regulation. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. In addition they had sustained previous good practice. As a result of this inspection the service has an overall rating of Good.

Why the service is rated Good.

Even though the manager had only been in post for four weeks their appointment had already significantly helped improve the previous lack of management of the service. Their previous experience as a registered manager had equipped them with the skills and knowledge required for their roles and responsibilities. It was evident they were confident and committed to embrace the new challenges and to improve 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.

The manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these.

People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Staff had the knowledge and skills they needed to carry out their roles effectively. They felt supported by the provider and the manager at all times. The manager and nurses had a good understanding of the Mental Capacity Act 2005 (MCA). The care staff understood it’s principles and the importance of supporting people to make decisions and protect their rights.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. Staff demonstrated a genuine passion and commitment for the roles they performed and their individual responsibilities. It was important to them those living at t

This inspection took place on 9 August 2016 and was unannounced. There were no concerns at the last inspection in May 2013. Edgemont View Nursing Home provides accommodation for up to 21 people. At the time of our visit there were 19 people living at the service.

There was a manager in post but they were not registered. 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.

Despite the views of people and their relatives, improvements were required in a number of areas.

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. Monitoring of the quality of the service was not always effective.

The manager and staff followed procedures which reduced the risk of people being harmed. 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 services 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 moved into the service only when a full assessment had been completed and the manager was sure they could fully meet a person’s needs. People’s needs were assessed, monitored and evaluated. This ensured information and care records were up to date and reflected the support people wanted and required.

Staff had the knowledge and skills they needed to carry out their roles effectively. People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The 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 prompt action when people required access to community services and expert treatment or advice.

References were made by relatives and staff about the ‘family atmosphere and homely feel’. Staff were knowledgeable about people they supported and it was clear they had built up good relationships. Family and friends had completed surveys this year and expressed their gratitude to staff and the services provided.

The manager had settled in to their role and had started to look at how they would continue to improve the service for people and staff. The service was important to them and they wanted the best for people. There was an emphasis on teamwork and unity amongst all staff at all levels.

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

Part of this inspection was to follow up two outcome areas where the provider was not compliant at the inspection of November 2012. The areas of non compliance were that the provider was not always meeting people’s nutritional needs and unsuitable infection control practices were in place.

Following the inspection of November 2012 we saw that significant improvements had been made including new guidance for staff, additional training and updates, new equipment had been purchased. There was increased observation and monitoring at mealtimes and policies and procedures had been reviewed.

People were being looked after and supported appropriately by all staff. They were happy and positive about the home, the staff and the lives that they were living.

Staff were dedicated and wanted the best for people in their care. It was evident through observation and in discussions that they enjoyed working in the home and supporting people.

On the day of our visit the manager was not present. The nurse in charge supported the inspection visit. They were knowledgeable about people in their care, the staff group and policies and procedures that supported the running of the home. The nurse took notes throughout the inspection to share with the manager. Following our visit we spoke with the manager over the telephone and provided feedback from our visit. They provided us with further evidence to support the outcomes we looked at.

We were introduced to people, visitors and staff throughout the visit and we were welcomed. Some people remembered us from the inspection of March 2012 and were happy to share their experiences with us. We saw some good examples where people were cared for well and people told us they were happy living in the home.

One person told us, “I have settled in very well, I have some very good relationships with staff and they cheer me up. It’s all been very positive since moving here and I feel I am in good hands”. Other experiences and positive outcomes for people who use the service are referred to throughout this report.

Some areas of care required improvements and potentially put people at risk. Staff were receptive about what we had found and agreed that the quality and safety could be improved with additional training and support from colleagues and management. Staff we spoke with told us they were proud to work there and wanted to continue to improve the service they provided.

We spent some time in the company of people living in the home and spoke with them

individually. People and their families expressed positive experiences. Staff interacted with people in a caring, respectful manner and people responded to this.