This unannounced inspection took place on 5 November 2018. Edward House is a 'care home'. People in care homes receive accommodation and nursing 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.

Edward House is situated in Burgess Hill in West Sussex and is one of a group of homes owned by the provider, Nicholas James Care Homes Limited. Edward House is registered to accommodate 22 people. At the time of the inspection there were 19 people accommodated in one adapted building, over two floors. Each person had their own room and access to communal bathrooms. The home provided accommodation for older people and those living with dementia.

The home had a registered manager. A registered manager is a ‘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 home is run. The management team consisted of the registered manager, a deputy manager and senior care assistants. An area manager also regularly visited and supported the management team.

At the previous inspection on 11 April 2016, an area identified as needing to improve was people’s access to stimulation and interaction, to occupy their time. At this inspection, it was evident that improvements had been made. An activities coordinator had been recruited and people were provided with activities that they found engaging and enjoyable. People had also enjoyed visits outside of the home. One person told us, “They are very good to me. I went to a World War Two local airfield where they have a museum with pictures of the aircraft that flew from there. I enjoyed that”.

Although improvements had been made since the previous inspection on 11 April 2016, at this inspection we identified concerns about the care people received. Medicines were not always administered or managed safely. One person who had a specific healthcare condition, did not always receive their medicines in a timely or person-centred way. Appropriate checks to ensure people received the correct medicines were not always made. One person, who was living with dementia, accessed the community independently. The registered manager had not identified, or taken appropriate action, to mitigate potential risks that might occur. Another person, sometimes displayed behaviours that challenged others. Staff told us that these occurrences were becoming more frequent. An incident had occurred where another person, as well as a member of staff, had been struck by the person. The registered manager had not considered this in accordance with the provider’s safeguarding procedures and had not raised the incident with the local authority, so that this could be considered under safeguarding guidance. The failure to identify and mitigate risks, to ensure people were receiving safe care and treatment, was an area of concern.

There was a lack of oversight of staff’s practice and of the systems and processes that were in place to ensure people received good care. Audits conducted by the registered manager as well as the provider, had failed to identify shortfalls that were found at the inspection in relation to medicines management, a potential safeguarding concern, staff competence in relation to dispensing and administering medicines and a lack of understanding about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Neither had they identified that there were insufficient assessments and guidance provided to staff in relation to people’s specific healthcare needs. That reviews had sometimes failed to identify any changes in people’s needs or support requirements. That staff had failed to accurately document decisions that related to people’s care. Care was not always person-centred and people's expressed wishes, about the gender of their care giver, was not alw

The inspection took place on 11 April 2016 and was unannounced.

Edward House provides accommodation for twenty-two older people, some of whom are living with dementia, who may need support with their personal care needs. On the day of our inspection there were eighteen people living in the home. The home is a large detached property situated in Burgess Hill, it has a communal lounge and dining room and a garden.

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.

There was a lack of stimulation for people. Observations of an activity in the afternoon showed people enjoyed taking part in the activity and this provided a sense of fun and enjoyment. However this was the only activity or stimulation provided throughout the day and people spent most of their day sitting in their chairs with little to do. People and relatives both felt that the activities provided needed to improve. One person was overheard saying “I am sitting around all day and doing nothing.” A relative told us “There could be more things to do I think, but I understand an activity co-ordinator starts next week so that should be good.” This is an area of practice in need of improvement.

There were sufficient numbers of staff to ensure people’s needs were met and their safety maintained. Staff had received induction training and had access to ongoing training to ensure their knowledge was current and that they had the relevant skills to meet people’s needs. People were safeguarded from harm. Staff had received training in safeguarding adults at risk, they were aware of the policies and procedures in place in relation to safeguarding and knew how to raise concerns. People felt safe, one person told us “I don’t think about it really so it must be safe.”

Risk assessments had been undertaken and were regularly reviewed. They considered people’s physical and mental health needs as well as hazards in the environment and provided guidance to staff in relation to the type of support people needed and the amount of staff required. People were encouraged and enabled to take positive risks. People’s independence was not restricted through risk assessments, instead risks were assessed and managed to enable people to be independent. Observations of people assessed as being at risk of falls showed them to be independently walking around the home. Staff were aware of the importance of keeping people safe whilst not restricting their freedom. One member of staff told us “Keeping the residents safe is a priority but not to the exclusion of everything else”. There were low incidences of accidents and incidents, those that had occurred had been recorded and were used to inform practice.

People received their medicines on time and told us that if they were unwell and needed medicines that staff provided these. People were asked for their consent before being offered medicines and were supported appropriately, being offered a drink to take their medicine safely and comfortably. Medicines were administered by trained staff and there were safe systems in place for the storage, administration and disposal of medicines.

People were asked for their consent before being supported with anything. For people who lacked capacity, mental capacity assessments had been undertaken to ensure best interest decisions were made on their behalf. People who were deprived of their liberty had appropriate applications made to the local authority to ensure that they were not being treated unlawfully.

People had access to relevant external health professionals to maintain good health. Records confirmed that external health professionals had been consulted to ensure that people

When we visited Edward House, there were 18 people living there. We spoke with four of the people and asked them about their experiences of using the service. They told us that they were well supported by staff and they were happy at Edward House.

The other people living at the home had complex needs and were not able to tell us about their experiences. Hence we used a number of different methods to understand their experiences of the service. We spoke with five relatives, a health care professional, the deputy manager and four members of staff. The relatives told us that they were satisfied with the level of care their relative received. They told us that they were involved in the planning of their care. They were kept informed about any changes in the care provided to their relatives. Staff told us that they understood the needs of the people living at the home and that they were able to support them. We looked at the care records of people and found that they contained the relevant information about the individual. We found that pre assessment had been carried out prior to admission. The care plans were reviewed on a regular basis and any changes in care needs were properly recorded.

We saw staff treating people with respect and helped them to be in control wherever possible. The relatives told us that they knew how to raise issues with the management. They were confident that management would listen to their concern and that it would be addressed appropriately.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences. We gathered evidence of people’s experiences by reviewing care records and speaking with relatives of people living at the home.

The provider told us people views were taken into account in the way in which they were cared for. A relative told us they were kept abreast and they were consulted when changes were made to their care their relative received.

We found people were pre assessed prior to coming to the home to live. Care and treatment was delivered and planned in relation to people’s care plan.

Staff told us they were supported and received appropriate training to deliver care to meet people's needs. We found staff were supervised and appraised.

We found that feedback from people, their representatives and other health professionals was used to assess and monitor the quality of the service delivered and to make changes.

During our visit, we found that people living in the home were settled and well cared for. This was reinforced by positive comments received and also evident from direct observation of effective interaction and of individuals being supported in a professional, sensitive and respectful manner:

‘Placing my mother in Edward House was the best choice for us. It’s such a comfort to know how all the staff work together to provide such excellent care’.

‘I’m very happy living here, it’s so comfortable and I couldn’t wish for anything better. The staff are all very kind and the food here is very good’.

‘My mother always looks very clean and well cared for. I’m always made to feel very welcome when I visit and I have absolutely no concerns’.

We were told that, in accordance with their identified wishes and individual care plans, people were encouraged and enabled, as far as practicable, to make choices about their daily lives.