This inspection took place on 10 and 15 August 2017. The first day of the inspection was unannounced. This meant the staff and manager did not know we would be visiting. This was the provider’s first inspection since they became registered providers of Eden House Residential Home.

Eden House Residential Home provides personal care and accommodation for up to 53 people over three floors. The service was supporting 51 people at the time of this inspection. The home has a residential unit on the ground floor to accommodate 27 people and a unit on the first floor called ‘The Grace Unit’ to accommodate 26 people who are living with dementia. The second floor contained a hairdressing salon with nail bar and staff rest rooms.

The service had a 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 we rated the service as outstanding in effective, caring, responsive and well led. At this inspection we found they remained outstanding in caring. We identified minor shortfalls in people’s care plans, the service no longer had staff champions in place and the provider’s quality assurance system was not fully embedded. We took these issues into account when deciding upon the ratings for this service at this inspection.

Staff were extremely caring in their approach ensuring people were at the forefront of their work. Staff were motivated and offered kindness, empathy and supported people to maintain links and ties with friends and family. Staff used inclusive methods of communication which were tailored to the needs of the people who lived at the home. The service had a strong, visible, person centred culture which was evident through the actions of the manager and staff. The service provided good end of life care that had a positive impact on people and their relatives at difficult and upsetting times. Staff discussed interventions with people before providing any support. Independence was promoted where ever possible. Advocacy services were advertised in the foyer of the service, accessible to people and visitors.

Risks to people and the environment were assessed and regularly reviewed and control measures were in place to mitigate against identified risk. Accidents and incidents were recorded and analysed to identify trends or themes.

Medicines were administered using an electronic system by trained staff that had their competencies to administer medicines checked regularly. Medicine audits were completed regularly. Policies and procedures were in place for safe handling of medicines for staff to refer to for information and guidance.

There were robust and thorough recruitment processes in place with all necessary checks completed before staff commenced employment.

The provider used a dependency tool to ascertain staffing levels which was reviewed regularly to ensure appropriate levels of staff were deployed in the home to ensure the safe delivery of care. People wore pendants to summon assistance with staff carrying pagers to enable them to respond in a timely manner.

There were systems in place to keep people safe. We found staff were aware of safeguarding and whistleblowing processes and how to raise concerns if they felt people were at risk of abuse or poor care practices. Accidents and incidents were recorded and monitored as part of the manager’s audit process.

The provider ensured appropriate health and safety checks were completed. We found up to date certificates to reflect fire inspections, gas safety checks, and portable appliance testing were in place.

A business continuity plan was in place to ensure staff had information and guidance in case of an emergency. An emergency grab bag containing

This was the first comprehensive inspection carried out at Eden House since the home was registered by CQC in October 2013.

Eden House provides care for up to 53 older people. Nursing care is not provided. The home has a residential unit on the ground floor for 27 people and a dementia care unit on the first floor for 26 people.

We saw very spacious communal areas comprising of several smaller lounges and dining areas.

All bedrooms had en-suite facilities. All areas throughout the home including, bathroom and WCs had been designed to accommodate people’s health, physical and wellbeing needs. For example,

24 hour free internet access, computers in the library and a direct dial telephone in every room.

There was also an integrated music system in every room including the bathrooms. All furniture and fittings were highly attractive and designed to a very high standard. People had easy access to very attractive landscaped gardens with walkways and seating. Many bedrooms on the ground floor had direct access to the gardens. We found the provider had considered the design of the building and put arrangements in place to ensure the premises met people’s needs. People described the home as, “Absolutely luxurious, “Five star hotel” and, “I never thought I would live in a place like this, it’s so beautiful.” This meant the provider had put in place facilities to support and improve the quality of life for people living in the home. When we inspected the dementia care unit, we saw that a tremendous amount of work and effort had taken place since the unit opened to create a dementia friendly environment

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.’ We found the service to be extremely well led.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out robust checks when they employed staff. We found staff treated people with dignity, respect, kindness and compassion. People had contributed to how the service was managed and some were involved in the recruitment of staff.

We saw evidence that thorough investigations had been carried out in response to safeguarding incidents or allegations and these had also been reported to CQC by the provider.

We saw a copy of the provider’s complaints policy and procedure and saw that complaints had been fully investigated with a written response to the complainant.

We saw comprehensive medication audits were carried out regularly by the management team.

Training records were up to date and staff received regular supervisions, appraisals and a personal development plan was also completed, which meant that staff were properly supported to provide care to people who used the service. The provider opened its own training academy in January 2015 for internal and external courses; it has a training kitchen and a bedroom for hands on training and had multimedia facilities for staff to use. The academy is overseen by a training manager. Staff at Eden House told us the training facilities within the academy were excellent.

We saw staff supporting people in the dining rooms at lunch and a variety of choices of food and drinks were being offered. We found the provider had implemented innovative pureed food techniques based on research and success within the organisation since December 2014. People told us this had made a big difference to their lives, they told us the meals tasted better and were very well presented.

We saw evidence that the service had sustained outstanding practice, development and improvement since the home opened. We saw leadership in the service worked towards, and had achieved outstanding practices to provide a quality service that contributed to the development of best practice for people who used the service. Staff told us they had encompassed these changes and new ideas that had been introduced by the provider such as new techniques for pureed foods, oral care and with the opening of the new training academy. Staff recognised the importance of new concepts of care and these had motivated them to aim for continuous improvement.

All of the care records we looked at contained care plan agreement forms, which had been signed by the person who used the service or a family member.

The home was clean, spacious and suitably adapted for the people who used the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the registered manager and looked at records. We found the provider was following legal requirements in the DoLS.

People who used the service, and family members, were extremely complimentary about the standard of care provided. They told us they and their family member were involved in all decisions about the care, treatment and support they received.

We saw staff supporting and helping to maintain people’s independence. We saw staff treated people with dignity, compassion and respect and people were encouraged to remain as independent as possible.

We saw that the home had a full programme of activities in place for people who used the service, including meaningful activities for people living with dementia. We saw people were encouraged and supported to remain involved in community life.

All the care records we looked at showed people’s needs were assessed before they moved into the home and we saw care plans were written in a person centred way and people using the service were consulted and included in decisions about all aspects of their care. People confirmed their wishes and preferences were respected.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources including people who used the service and their family and friends. We saw the provider strived through feedback to sustain continuous improvement.