The inspection took place on the 12 October 2016 and we revisited on the morning of the 14 October 2106 to look at a number of further documents. The first inspection date was unannounced. The last inspection to this service was in May 2014 and the service was compliant under our methodology used at that time and has a history of compliance. Since the date of the last inspection there has been a change in manager and an increase in bed numbers from 35 to 40. There were 34 people using the service at the time of our inspection with a number of people booked to arrive.

On the day of our inspection there was a manager in post who has subsequently put in an application to the 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.

During our inspection we found the staff working at the service were mostly regular members of staff and had managed well with all the recent changes to the service. A new manager had been recruited and a number of new staff had either started or were about to start work. Staffing numbers were being maintained but we felt numbers were on the low side particularly at night time when staffing levels was reduced to two staff. A number of people required two to one to assist with their manual handling needs. This meant there were no staff on the floor at some point during the night to assist others. We also felt there were insufficient time for activities, as reflected by people using the service and from the planner which showed activities planned on some days but not others. The activities which were provided were enjoyed. People expressed their appreciation for the staff and felt they worked hard to ensure their needs were met.

People received their medicines in a safe way by well-trained knowledgeable staff. Staff received the training they needed to be effective in their role and their performance was assessed and monitored.

People’s needs were known by staff and potential risks associated with their care were mitigated as far as reasonably possible through robust risk assessments and through staff training. The environment was suitable to people’s needs and was well maintained. Equipment was checked regularly to ensure it was safe to use.

Staff were regularly supervised to ensure that their work practices were in line with best practice and staff received adequate training for their role.

There was a robust complaints procedure and the service were responsive to any feedback given.

People’s health needs were monitored by staff so appropriate steps could be taken or medical intervention sought as required. Staff helped ensure people ate and drank enough for their needs to help maintain their weight and good health.

People were consulted about their care and consent was sought before any care was provided. The service worked in accordance with the law in terms of supporting people without capacity to make their own decisions.

People only moved to the service when an assessment of their needs confirmed the service was able to meet them. Needs were not always kept under review in a timely way. This might result in an increased risk of people not having their needs met or the service failing to recognise if staffing levels were adequate.

The service was well managed and there was a positive culture in the service. Staff development was supported and encouraged and good practice was the norm. People were receiving a good service and were actively asked for their suggestions to help the service shape and improve the service as required.

We considered our inspections findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

The five people we spoke with who used the service all confirmed to us that they were well cared for and that care staff always treated them with dignity and respect. People, their relatives or representative had signed that they agreed to the care and support and how these were to be provided. Reviews of people's plans had been completed regularly and ensured that people were only provided with care based upon their most up to date care information. Relatives and people we spoke with confirmed to us that they, or their relative, had a positive, or very positive, experience of using the service. One relative said, "Mum gets the support she needs whilst also respecting her independence."

Is the service responsive?

People's plans of care had been developed with them and were based upon an accurate assessment of people's needs. This ensured that people's needs were consistently met. People were provided with individual support in response to things identified by health care professionals. Changes were made to the way care and support was provided to people where this had been identified. People were referred to their health care support professionals such as their GP, optician or chiropodist where the person required this. Staff were provided with training to meet the needs of people who used the service.

Is the service safe?

Records we looked at demonstrated to us that statutory inspections and checks had been reliably completed for things such as gas, electric and water safety. We saw that regular reviews of people's assessed health risks such as risks of malnutrition, use of bed rails, choking and personal mobility had been completed. Checks completed by the provider and staff ensured that people's records, staff training and assessments of people's mental capacity had been completed to ensure that people were safe. One person told us, "I feel safe living here. I only get to see the people I want to see at the time I am happy with." Where accidents or incidents had occurred we saw that appropriate action had been taken to prevent, or reduce, the potential for any repeat occurrences. We saw that people using the service had not been unlawfully deprived of the liberties.

Is the service effective?

Staff we spoke with were able to tell us the detailed care needs for each person and also their preferences. Our observations of staff supporting people confirmed to us that people had a good experience of using the service. Quality assurance reviews which had been completed by the provider had confirmed that people were satisfied or very satisfied with the quality of care they were provided with. One relative said, "Mum did have a few falls at home but since she has lived here they have provided equipment and staff support to ensure she has effective care." People were reliably supported to see, or be seen by, health care professionals

Is the service well led?

A registered manager was in post at the service and had been so for several years. All of the staff we spoke with told us that the manager was very good and was regularly to be seen around the home even at night times. Staff and the manager told us that if ever they had any concerns or something needed changing that action was taken as soon as practicable. We saw that there were on-going improvements to the premises and activities for people to partake in. Changes to staff employed by the service ensured people were provided with a variety of social and relaxation activities. Effective quality assurance systems were in place and concerns raised by people, staff and visitors were acted upon. Records we looked at had been checked at regular intervals to ensure people were only provided with care that they had agreed to.

As part of our inspection we spoke with four people who used the service and four people’s relatives. We found that people expressed their views and were involved in making decisions about their care and treatment. One person we spoke with told us, “It’s lovely here, there’s plenty of help and they look after you well.” A relative told us, “The care is what’s most important and its good here. People are treated as individuals.”

We found that care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare and there were effective systems in place to reduce the risk and spread of infection.

We saw that medicines were stored safely and administered correctly. There were enough skilled, experienced and qualified to staff to meet people’s needs. We also found that people’s complaints were fully investigated and resolved, where possible, to their satisfaction.

As part of our inspection we reviewed eight care records and found that people’s personal records were not always accurate and fit for purpose.

People we spoke with told us staff members treated them with dignity and respect and that they spoke to them in a friendly, relaxed manner. One person we spoke with told us, “I think it is lovely here, the staff are very kind”.

People told us they felt well cared for by staff at St Edmunds and they received the treatment they expected from external care providers, such as district nursing services.

During our inspection we saw that people lived in a comfortable home, with access to a variety of communal areas. We also found that the home's environment promoted and stimulated people's well being and memory, and that it was well maintained to ensure their safety

The provider's recruitment procedures ensured that only the right people were employed to provide care to vulnerable adults.

People were regularly asked for their views on the way services were provided at the home, and the provider listened and acted on suggestions made.