This inspection was unannounced and took place on 2 and 14 February 2017. St Edmunds Residential Home provides accommodation and care for up to 39 older people. It is not registered to provide nursing care. At the time of our inspection there were 35 people living in the home.

A new manager was in post and an application for them to become registered was being processed by CQC. 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 and July 2016, we found the provider was in breach of four of the

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found improvements had been made and the provider was no longer in breach of these regulations.

People were safe living in the home. The provider had completed the required remedial works to ensure the safe management of water systems and staff had completed training in Legionella.

The systems for medicines management and administration had improved. Medicines were managed safely and people received their medicines as prescribed. An air conditioning unit had also been installed in the medicines room, to ensure medicines were stored at the correct temperature. Staff who administered medicines had undergone competency assessments.

The management team were using a dependency tool to help ensure sufficient staff were on duty to meet people’s needs. Additional staff had been recruited to cover identified shortfalls in staffing levels. Staff deployment and staff breaks had been revised, to ensure enough staff were available to support people during mealtimes.

A proactive and positive approach to risks was being taken by staff and the management team. Staff and the management team worked collaboratively with other professionals to ensure risks to people were managed properly. Risk assessments had been reviewed and updated with people and their GPs, in respect of any possible adverse effects caused by drinking alcohol when prescribed certain medicines.

Infection prevention and control was being managed safely. The domestic team worked in accordance with advice received from the NHS Infection Prevention and Control Team.

Risks were identified and appropriate risk assessments were in place with regard to protecting people from developing pressure sores. Staff had received training in care planning and the format of care plans had been revised to ensure information regarding such risks would not be missed.

The risks to people from not eating or drinking enough were well managed. People’s weights were being recorded appropriately, to ensure people were protected from the risk of malnutrition and people had easy access to drinks when they wanted them. Staff had received training to ensure the correct and complete recording of people’s food and fluid intake and the management team ensured these records were appropriately maintained.

People were offered choices of food and drinks at mealtimes and menus were available in the dining and communal areas. The cook maintained an up to date list of people’s dietary requirements and diabetic diets were catered for appropriately.

Staff were recruited in a way that ensured proper checks were carried out. This helped ensure only staff who were suitable to work in care services were employed.

Staff knew how to recognise different kinds of possible abuse and understood the importance of appropriately reporting any concerns or suspicions that people were at risk of harm.

Staff were being trained well and were competent in meeting people's needs. Staff understood people's backgrounds and preferences and supported people effectively. New staff were required to complete a probationary period and

This inspection took place on 23 and 30 June and 6 July 2016 and was unannounced. St Edmunds Residential Home provides accommodation and care for up to 39 older people. At the time of our inspection there were 37 people living in the home.

The service had 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.

The provider had not ensured that the water system in the home was safe. Following concerns raised by health professionals a full risk assessment of the system was carried out by an external contractor. This found that the water system was at high risk of the legionella bacteria. The legionella bacteria can cause Legionnaires disease. This is a pneumonia type infection that affects the lungs and respiratory system which can prove fatal in a small percentage of cases.

Hot water temperatures were very high in many people’s ensuite bathrooms. This presented a risk of scalding. These high temperatures had been known about for several months, but no corrective action had been taken.

In order ensure that no further people would be exposed to the risk of harm whilst the water system in the home was being made safe we issued an urgent Notice of Decision to prevent the provider admitting further service users to the home. This means that that the provider’s registration to operate the home is conditional upon no new service users being admitted.

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.

This inspection found that the provider was in breach of four regulations. These related to safe care and treatment, staffing, meeting nutritional and hydration needs and governance.

Several people enjoyed alcoholic drinks. However, no risk assessments had been carried out to determine whether there were any risks to people from this, and if so, how these could be mitigated. For example, alcohol can adversely interact with medicines.

People were not always weighed on a regular basis. This meant that where people were at risk of not eating enough, it could have been identified earlier. Steps then could have been taken to provide additional support sooner.

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