A comprehensive inspection visit took place on 20 August 2018 which was unannounced. We returned announced on 22 August 2018 so we could review the provider’s quality assurance systems and to speak with more staff about what it was like to care for people living at Eden Place.

Eden Place is a mental health nursing home, which provides care for up to 34 people over three floors. At the time of our inspection there were 32 people living at Eden Place. People had their own bedroom and some bedrooms had en-suite facilities whilst others shared communal bathrooms. Eden Place had a secured outdoor area and was monitored externally by CCTV, with the entrance to the home accessed by an electronic gate.

People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A requirement of the service’s registration is that they have 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 and the associated Regulations about how the service is run. At the time of our inspection visit there was a registered manager, however they were away from the home on maternity leave. An interim manager had been appointed to cover this absence from 6 August 2018.

At our last comprehensive inspection in September 2017, we rated the service ‘Requires Improvement’ overall. At this inspection we found the evidence continued to support the rating of Requires Improvement. This was because there remained limited understanding of working within the principles of the Mental Capacity Act 2005. The provider’s quality assurance systems required greater improvement and because there continued to be limited improvement, we found this was a continued breach of the regulations. Some improvements since the last inspection had been addressed, for example, medicines management and the provider had submitted statutory notifications to us when notifiable incidents had occurred.

Care plans required more personal and individualised information for staff to provide care to people in a more person-centred way. For people who had recently moved to Eden Place, a lack of detailed care plan information meant staff did not have the knowledge they needed to know about that individual. For people assessed as being at risk, risk assessments needed more information so staff could manage risks to people safely.

Staff protected people from risks of abuse. All staff understood what actions they needed to take if they had any concerns for people's wellbeing or safety. Staff felt confident to raise concerns to the management and provider.

Staff received regular refresher training to meet people’s needs, and effectively used their skills and experience to support people. People’s care and support was provided by a caring and consistent staff team and there were enough staff to provide care when people needed it.

Staff did not always work within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge was not always consistent to ensure people received the right level of support. Care records did not always include the support people needed to make specific decisions where they lacked capacity.

Staff were caring in their approach and interactions with people. However, the lack of investment in keeping the environment safe and risk free showed the provider had not always considered how their actions impacted on those in their care.

There was limited stimulation for people to be involved in leisure interests to keep them active and to have fulfilling lives. People and staff were working

This inspection took place on 21 September 2017 and was unannounced.

Eden Place Mental Health Nursing Home is registered for a maximum of 33 people offering accommodation for people who require nursing or personal care and requiring treatment for substance misuse. At the time of our inspection there were 31 people living at the service. People using the service were being supported with their mental health needs and no one was requiring treatment for substance misuse. Eden Place was last inspected by us in July 2015, and we rated the home as Good.

The home 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.

People’s medicines were not always administered as prescribed, and medicines records did not always demonstrate that medicines were administered consistently. Some prescribed creams were being administered by care staff who had not been trained to do so. Audits designed to check medicines practice was safe and in line with best practice had not identified some of the issues we found.

Action had not always been taken to keep people safe in response to incidents that took place within the home.

Where people did not have capacity to make their own decisions, this had not always been assessed and documented. It was not always clear who was authorised to make decisions in people’s best interests, and applications to deprive people of their liberty had not always been made as required.

Systems in place to check the quality of the service provided were not effective, as they had not identified the concerns we found during our inspection. The provider had not always notified us of incidents that occurred in the home which is their legal requirement to do.

People told us they felt safe with the staff who supported them, and we saw people were comfortable with staff. Staff received training in how to safeguard people and understood what action they should take in order to protect people from abuse. The provider ensured staff followed safeguarding policies and procedures.

There were enough staff to meet people’s needs effectively. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people. Staff told us they had not been able to work until these checks had been completed.

People were asked for their consent before staff supported them. People had access to health professionals when needed and care records showed support provided was in line with what had been recommended.

People were offered a choice of meals and drinks that met their dietary needs, and where they were at risk, their food and fluid intake was recorded and action taken where required.

People and relatives told us staff were respectful and treated people with dignity. We observed this in interactions between people, and records confirmed how people’s privacy and dignity was maintained. People were supported to make choices about their day to day lives. For example, they were supported to maintain any activities, interests and relationships that were important to them.

People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication needs, their likes, dislikes and preferences. People were involved in how their care and support was delivered.

People and relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. People and staff told us the management team were approachable and responsive to their ideas and suggestions.

We found breaches of the Health and Social Care Act 2008 (Regulated Activitie

We reviewed the provider's compliance with a number of essential standards in July 2013, as part of a planned inspection. This inspection was carried out to look at all the information we had received since we told the provider where they needed to improve. We found improvements had been made in the areas we had identified where we had previously had concerns.

We spoke with six people living at Eden Place Mental Health Nursing Home who told us about their experiences of the service. We spoke with three members of staff and the manager.

People we spoke with told us that their care plans were discussed with them on a regular basis. We saw that people were involved with the reviews of their care and where possible, they had signed their care plan.

We saw that staff listened to people about their care needs and their wishes. We saw people's independence was promoted within their care plans and on the day of our inspection.

We saw quality assurance checks had been implemented and the manager told us how these worked. We saw that meetings had been held for people who lived at the home.

We saw people’s care records, including risk assessments, were accurate and fit for purpose. We reviewed six care plans and found the records were easily accessible.

We spoke with seven people who lived at Eden Place Mental Health Nursing Home about their experiences of the service. We also spoke with a relative, four members of staff on duty and the registered manager.

People we spoke with told us that the care planning was not discussed with them. We found there were regular reviews of people's care but it was not clear how people or relatives had been involved. We saw people's independence was promoted within their care plans and on the day of our inspection.

We saw that the care plans were person centred and reflected people’s individual needs. We found the member of staff supported people as detailed within their care plans. We noted they were compassionate and caring when supporting people.

We found the home was clean and there was a cleaning schedule which the member of staff followed. We saw checks were made by the member of staff to review the cleanliness of the home.

We saw the provider ensured that the appropriate checks were undertaken before a new member of staff was employed. The manager told us about the induction plan which new staff had to complete during their employment by Eden Place Limited.

We found the service did not have a robust system in place to monitor the quality of care plans.

We saw care plan records were not always fully completed as some sections remained uncompleted. We found the records were unclear on whether the care plan was current or if there had been any amendments to the plan.

We reviewed the service's compliance with a number of essential standards in June 2012, as part of a planned inspection. This inspection was carried out to look at all the information we had received since we told the provider where they needed to improve.

We spoke with two people living at Eden Place Mental Health Nursing Home who told us about their experiences of the service. We spoke with two members of staff, the deputy manager and the manager.

People we spoke with told us they were happy with the service and 'liked' it at Eden Place Mental Health Nursing Home. People also told us that staff were friendly and supported their needs.

We spoke with staff who told us how support for staff had improved since our last inspection. They told us that teams are been restructured and the sharing of information between the team had improved.

We saw quality assurance checks had been implemented and the manager told us how these worked. We saw that resident meetings were held and a resident survey was due to be undertaken.

We spoke with four people who lived at Eden Mental Health Nursing Home and we looked at three care plans. We also spoke to a Registered Mental Health Nurse (RMN) and two members of staff.

People we spoke with told us that the care they received matched the care that was discussed with them. People told us that they were involved in their care and would hold monthly discussions with the RMN about their care plans. We saw that care plans were reviewed on a monthly basis and was signed by the people involved with the review.

People we spoke with told us that staff were friendly and supportive with their needs.

People we spoke with told us that felt safe within the home and knew who to speak to if they had any concerns. We saw in people’s bedrooms that there was information about who to speak to, if a person wanted to make a complaint or had any concerns.

We saw that there was a safeguarding policy available for staff which needed to be updated. We saw that the registered manager had identified that the safeguarding and restraint policy was outdated. The registered manager was reviewing and updating the policies to ensure they were up to date.

People we spoke with told us that they received the correct medication and it was administered at the right time. We saw that medication was handled appropriately and administered safely.

Staff we spoke with told us about the training they had undertaken and the support they received. Staff told us that there was no formal system to cascade information or formal supervision session. There was no training matrix available to identify where there were any gaps in staff training. We spoke with the registered manager who had identified the area of formal supervision and information sharing as a concern.

We saw that the provider did not have a system to regularly seek the views of people using the service. We saw that there was no robust system to monitor the quality of service that people using the service receive.

We carried out this inspection on 22 and 23 July 2015. The inspection was unannounced.

Eden Place Mental Health Nursing Home is registered for a maximum of 34 people offering accommodation for people who require nursing or personal care and requiring treatment for substance misuse. At the time of our inspection there were 32 people living at the service, two people were in hospital. People using the service were being supported with their mental health needs and no one was requiring treatment for substance misuse.

A requirement of the service’s registration is that they have 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post.

Support was provided that met people’s needs and we found there were enough staff to care for people safely. Staff referred people to other health professionals when needed, so people were supported to maintain their health and wellbeing. People’s health and social care needs were reviewed regularly. Risk assessments were completed and plans minimised risks associated with people’s care.

People told us they felt safe living at the service. Staff knew how to safeguard people and what to do if they suspected abuse. People were protected from harm as medicines were stored securely and systems ensured people received their medicines as prescribed. Checks were carried out prior to staff starting work at the service to make sure they were of good character and ensure their suitability for employment.

Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). When there were concerns about people’s capacity to make decisions, we saw decisions were made in their best interests.

Staff received training to do their jobs effectively, in order to meet people’s care and support needs. Staff were encouraged to continue to develop their skills in the area of health and social care. Staff told us they felt supported by the management team to carry out their roles effectively.

People’s nutritional needs were met and there was a variety of food available. Snacks and drinks could be accessed when people required these. Some people enjoyed taking part in organised activities, many people chose to go out either independently or with staff, and pursue their own interests.

People told us they liked living at the service and that staff were kind and caring. We saw people were cared for as individuals with their preferences and choices supported. Staff treated people with dignity and respect and encouraged people to be independent where possible. Relatives were encouraged to be involved in supporting their family members and told us staff members also offered them support.

People were positive about the management team and the running of the service. We saw the registered manager was responsive to feedback in developing the service, and making continued improvements. Systems and checks were in place and these made sure the environment was safe for people that lived there and that people received the care and support they needed. People knew how to complain if they wished to and complaints were recorded and actioned in a timely way.