The inspection was unannounced and took place on 12 December 2018. This was a planned inspection based on the rating at the last inspection when the service was rated as ‘inadequate.’ Since the last inspection we had also received some whistle-blowing concerns about care at the home and the inspection followed up on these concerns.

Edgeview is a nursing home. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Edgeview is registered to accommodate 24 people. At the time of our inspection 20 people were using the service. Edgeview accommodates people in three buildings. The main building, a bungalow where three people live and a converted stable building for a further three people. All areas are accessible from the main building. Some of the people living at Edgeview have learning disabilities or mental health needs. The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This was as the service was created a number of years before this guidance was published. These values should include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service are not always supported or to live as ordinary a life as any citizen.

We last inspected Edgeview on 28 March 2018, when we rated the service as ‘Inadequate'. We found the provider was in breach of the regulations regarding person centred care; dignity and respect; need for consent; safe care and treatment; good governance and staffing. Following the inspection, we imposed conditions on the providers registration and placed the service in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

When we carried out this inspection we found the provider had made significant improvements in the areas previously identified and the regulations were now met. The service is no longer rated as inadequate overall or in any of the key questions; therefore, this service is now out of Special Measures. However, as the last two inspection reports rated the service as ‘requires improvement’ and ‘inadequate; ‘ we need to be assured that the improvements made are embedded fully into practice and will be sustained over time, therefore the overall rating of this report is ‘requires improvement.’

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met. A revised system of recording accidents and incidents was now in place including a summary report, so any trends could be identified.

Staff were available to people and demonstrated good knowledge about people living at the home. People were supported by staff to have their medicines and records were maintained of medicines administered. Staff maintained good hygiene and used protective clothing when appropriate.

Staff told us training helped them meet the specific needs of the people living at the home and they attended regular training to ensure they kept their knowledge updated.

Staff understood the importance of ensuring people agreed to the care and support they received. The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) and had submitted the appropriate applications where they had assessed that people were potentially receiving care that restricted their liberty.

People enjoyed a choice of meals and were supported to access professional healthcare outside of the home, for example, visits with their GP and community health teams and any changes to

This comprehensive inspection visit took place on the 28 March 2018 and was unannounced.

Edgeview is a nursing home. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Edgeview is registered to accommodate 24 people in three buildings. At the time of our inspection 24 people were using the service. Edgeview accommodates people in three buildings. The main building has three floors, two communal living rooms and a large communal dining area. There is a separate building which is an activities room. There is also a bungalow where three people live and a stable for a further three people. All areas are accessible from the main building. Some of the people living at Edgeview have learning disabilities or mental health needs. The care service has not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This was as the service was created a number of years before this guidance was published. These values should include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service are not always supported or to live as ordinary a life as any citizen. Registering the Right Support CQC policy.

There is a registered manager in place. 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.

Following the last inspection, we asked the provider to make improvements to how people’s dignity was upheld, to consider how people made choices and to ensure that action was taken to protect people from potential harm. We found the provider had not made the necessary improvements.

Risks to people were not fully considered and when incidents occurred action was not always taken. When people had behaviours that may challenge themselves and others all areas of risk had not been considered for these people. People were not safe as poor moving and handling was observed and the information in people’s care plans was not always followed. People did not receive their planned care hours and we could not always be assured there were staff available for people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. When people had DoLS authorisations in place the conditions of these were not being met. Staff received training however we could not be assured this enabled people to receive the support they needed. Although there were procedures in place and staff demonstrated an understanding we could not be sure all incidents were appropriately investigated or considered as safeguarding.

We found people were not always supported in a dignified way. People’s choices were not considered and they were not always encouraged to be independent. Staff did not always positively interact with people and they were unsure how to support some people. People did not always receive care that was responsive to their needs. Staff did not always have the most relevant up to date information available to offer support.

The systems the provider had in place were not always effective in identifying areas of concern. Records were not always stored securely and annual feedback had not been obtained from people and relatives. There was a lack of leadership within the home.

There was an activity room and people could access this, people were also offered the opportunity to go out. There were infection control procedures in place and these were follow

We inspected this service on 7 February 2017. This was an unannounced inspection. Our last inspection took place in July 2014 and found no concerns with the areas we looked at.

Edge view Nursing Home provides accommodation and nursing care for up to 24 people with mental health and learning disability needs. Some people also have needs due to a physical disability. There were 24 people using 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.

People were not always supported in a dignified way. The choices they made were not always considered by staff who supported them. There was an on-going safeguarding concern at the home and the provider had not taken the necessary measures as identified in their risk assessment to ensure people were protected from potential harm.

People were happy with the care they received and the staff that supported them. There were enough staff available to offer support to people. Staff received an induction and training that helped them offer support to people. The provider ensured staffs suitability to work with in the home. Staff understood their responsibility in relation to raising safeguarding concerns.

When risks to individuals had been identified action had been taken to minimise this and risk assessments were in place. Medicines were managed in a safe way. When people were unable to consent, mental capacity assessments had been completed and decisions made in peoples best interest. The provider had considered when people were being restricted and authorisations for this were in place.

People enjoyed the activities they participated in as well as the food that was offered to them. When people needed access to healthcare professionals this was provided for them. People were encouraged to maintain relationships that were important to them. People knew how to complain and when needed the provider had responded to complaints in line with their procedures.

Staff felt listened to and supported by the registered manager. People knew how to complain and complaints had been responded to in line with the provider’s procedures. Staff knew people well and they felt involved with planning their care. The provider used feedback from people and relatives to bring about changes. Quality monitoring checks were completed to make improvements to the service. The provider notified us about significant events that occurred at the home so we could ensure appropriate action was taken.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 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 2008, and to pilot a new inspection process being introduced by the CQC which looks at the overall quality of the service.

This was an unannounced inspection. This meant that the providers, managers and staff did not know we were visiting. At the last inspection in September 2013 the provider met all the regulations we looked at.

Edgeview Nursing Home provides accommodation and nursing care to 24 people with mental health and learning disability needs. Some people also have needs due to a physical disability.

There was registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People were happy living at Edgeview Nursing Home. They told us that they had good relationships with the staff and that they treated them well. We saw that staff were caring and spoke with people in a compassionate and respectful way.

People received person centred care that took account of their individual needs, preferences and hopes for the future. People were supported to be as independent as possible making choices about their daily lives.

People had the chance to take part in lots of activities both in and out of the home. These were based around each person’s choices.

Plans of care were in place that gave good detail about the care each person needed. People were involved in planning their care. Care reviews were held and records were kept up to date. Records and discussions with people and health professionals confirmed that people were supported to have their health care needs addressed.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. The staff took action to support people to make decisions. Where people did not have the ability to make decisions these were made in their best interest by people who knew them. Where people were being restricted, the home had made the referrals and DoLS authorisations were in place.

Staff were subject to a robust recruitment process that made sure all the necessary pre-employment checks were completed. This ensured that appropriate staff were recruited to work with people. Staff were trained and supported to provide people with care that met their needs.

People that lived at the home, relatives and staff spoke well of the management of the home. They told us that senior staff were available to talk with them about care issues or any worries. They were confident that action would be taken if they raised issues of concern.

Systems were in place to review and check the quality of care and to make sure that people were kept safe. Staff were trained in safeguarding adults and knew how to respond if people were at risk of harm.

At the time of our inspection 22 people lived at the service. Due to the nature of their health condition not all of the people who lived at the service were able to talk to us. We observed the interactions between staff and the people who lived there.

We spoke with one visiting relative, 5 members of staff the registered manager and the regional manager.

We found that care plans were person centred and individualised. People’s preferences and interests were recorded. There were a wide range of suitable activities for people to join in with.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There was an effective system in place to reduce the risk of and control the spread of infection. Cleaning audits and schedules effectively identified areas of the home that required attention.

The provider had taken suitable steps to ensure that staff were of good character and for the work required. There were effective requirements procedures in place at the service.

Quality of care provided and the monitoring of the home was effective. The service had sufficient audit and monitoring measures in place to be able to identify what further training or action could be required.

We carried out this review to check on the care and welfare of people living at Edgeview Nursing Home. The visit was unannounced which meant the provider, manager and staff did not know we were coming.

There was a new manager in post at the home. They had not submitted their registered manager application to CQC. We were told this was in the process of being completed.

During our inspection we observed staff engaging with the people living at the home in a polite and supportive manner. Plans of care for people were available. We spoke with the manager, care staff and healthcare professionals about the support provided at the home. The staff we spoke with were knowledgeable about the level of support people required.

We asked staff about their understanding and responsibilities for safeguarding (protecting vulnerable adults) people living at Edgeview Nursing Home. The staff we spoke with gave us appropriate examples of what they would report and how they would raise concerns if necessary. All staff we spoke with said they able to speak with senior staff or management about any concerns.

We spoke with the manager and staff about training available to staff at the home. Staff told us they had training provided and had one to one meetings with the manager to discuss their performance and training.

System were in place for the quality monitoring of the service provided at the home.

There was evidence that people had been involved in the agreeing to a course of assessed, planned care, and that the home obtains the involvement of the person’s representative and or other professionals, as and when necessary. During the course of the inspection comments were received from several people using the service, and people visiting at the time. We asked for their comments on the quality of the service and care given. There was a clear appreciation of the openness and opportunity to contribute, one person visiting stated that “I can speak to staff at any time, if they were busy they would explain that and always return to me as soon as possible". Overall people were satisfied with the care and treatment they were receiving in the home; they told us that they were treated with respect and that visitors were made to feel welcome. One person told us that the staff were respectful and maintained her privacy, and another stated: “I have lived here for a long time and I still love being here, my room is brilliant, and the nurses are really good to me”.

We met with several people in the course of inspection who told us that the quality of the food was generally very good, and that they find the environment to be clean and tidy. We spoke with a variety of people using and visiting the service, each indicating their approval of a good standard of cleanliness throughout Edgeview nursing home. People confirmed that they received their medication when they needed it, and did not have any concerns. They told us of a confident and open relationship with the nursing staff, who were generally able to explain and clarify medicine issues with people.

Several people expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Some comments we received from people spoken to on the day were generally complimentary of the surroundings and the comfortable, safe living arrangements, and identified a confident and open relationship, based on mutual trust and respect: "My carer always listen to me, and try to meet my needs". We also found a readiness for people to express their views as to the quality of their care. The majority of comments were positive, mainly concerning the friendliness of the staff and the high standards of care.

We asked people if they knew how to make a complaint, and if they felt the service was lacking in any way. There were a few minor concerns expressed, some on the relationships with staff, and some about the quantity of food offered. However, generally the majority of comments about the quality of care were very complimentary.