Emerald House

Updated 30 July 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Emerald House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Emerald House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at home to speak with us.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke to two people who used the service, four staff including the registered manager, deputy manager and two support workers. We reviewed a range of records. This included three people's care records and three people's medicine records. We looked at three staff files in relation to recruitment and staff supervision. A variety of other records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We spoke with a social care professional who worked with the service to gather their feedback. We continued to seek clarification from the provider to validate evidence found.

Updated 30 July 2022

About the service

Emerald House is a residential care home providing personal care for up to three people in one adapted building. The service provides support to younger adults and people with mental health needs. At the time of our inspection there were three people using the service.

People’s experience of using this service and what we found

Staff supported people with their medicines, however, medicines administration was at times, carried out by staff who did not have up to date competency assessments to ensure they had the required skills and knowledge to complete their roles. Competency assessments did not include the administration of controlled drugs to ensure the risks of harm to people were reduced. 'As and when required' medicine protocols lacked information to guide staff when to administer medicines and ensure best practice guidelines were followed.

There were no measures in place to securely store and record controlled drugs, the registered manager ordered appropriate storage and recording for controlled drugs on the day of the inspection. Overstock of medicines which needed to be returned to the pharmacy was stored with current medication which could lead to people being given out of date medicines; a medicine return book was not in use to ensure returns were recorded accurately.

Quality assurance system was not robust enough to identify the risks found during the inspection. This placed people at risk of harm.

Information about risks and safety were not always identified or up to date. Risks that could put people at harm, for example, environmental risk assessments did not identify or address risks to individuals found during the inspection. We have made a recommendation about the management of risk assessments.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not support this practice as staff had not received training.

We have made a recommendation about the training of staff in relation MCA to ensure staff knowledge is up to date.

Staff were recruited safely. There were enough staff to meet people's care needs.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from

poor care and abuse.

Staff members were very positive about working at the service and felt supported by the manager and the provider.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for the service at the previous premises was good, (published on 27 November 2019). The registration of the service was changed on 31 March 2021, as the service moved to its new premises at the current location. Therefore the service will be referred to as newly registered throughout this report.

Why we inspected

This was a planned comprehensive inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to medicine management and oversight.

Please see the action we have told the provider to take at the end of this report.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.