Archived: Emerald House

Emerald House is a care home providing personal care for up six people with a learning disability, autism and/or mental health needs across two separate units, each of which have separate adapted facilities. At the time of our inspection three people were using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Everyone we spoke with was positive about Emerald House and the changes that had been made since the last inspection. We observed people and staff had developed good and caring relationships built on trust and mutual respect.

The provider had systems in place to safeguard people from abuse. Staff understood how to keep people safe. They recognised and reported any safeguarding concerns. Risk assessments were in place and medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to mitigate risks.

Staff were recruited safely and had the appropriate skills and knowledge to deliver care and support to people in a person-centred way. Some staff had worked at the service for a long time and this provided consistency for people.

Care plans contained relevant information about how to meet people's needs and were regularly reviewed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice.

People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks. People were treated with kindness and supported to express their opinion wherever possible.

People had access to a varied and balanced diet. Where required, staff monitored people's weights and worked with healthcare professionals to make sure people received medical attention when needed.

People and staff spoke positively about the registered manager. They felt able to raise concerns and were confident these would be addressed. Staff told us they were well supported by the registered manager and senior management team.

Checks of safety and quality were carried out to ensure people were protected from harm. Work took place to support the continuous improvement of the service and the registered manager was keen to make changes that would impact positively on people's lives

No one was in receipt of end of life care however, staff had developed positive professional working relationships with healthcare professionals and told us they would make the necessary arrangements to enable people to remain at home at this time, should the need arise.

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

Rating at last inspection

The last rating for this service was requires improvement (published 19 December 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Emerald House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Emerald House accommodates up to six people with a learning disability, autism and/or mental health needs across two separate units, each of which have separate adapted facilities. At the time of our inspection four people were using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a manager in post who registered with CQC in May 2018. 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 management of medicines was not robust and meant medicines were not administered to people as prescribed by their GP. This put people at risk of harm.

Newly appointed staff had not received appropriate training to enable them to effectively and efficiently carry out their job roles and duties. Meetings with staff to discuss work performance (supervisions) had not been carried out in line with the providers policy meaning some staff had not received any. This meant people’s health and well-being was at risk of harm.

The quality of the record keeping varied and some care records we looked at were not personalised and were inconsistent or incomplete. This meant staff did not have an up to date record of people’s care and treatment. The assessment, monitoring and mitigation of risk for people who used the service was not robust and care was not updated in respect of their changing needs.

The quality assurance system within the service was not being operated effectively. Audits completed by the provider and the registered manager failed to identify shortfalls in records, repairs required to the environment, medicines management, safeguarding reporting, risk management and care planning.

We found breaches of Regulations 12, 17 and 18 during this inspection in relation to; safe care and treatment, good governance and staffing. You can see what action we have asked the provider to take at the back of this report.

There were sufficient staff to meet people’s needs and staff recruitment processes were robust. Observations showed staff were compassionate, kind and caring and had developed good relationships with people using the service. Staff knew people well and promoted their dignity and respected their privacy.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, policies and procedures in the service supported this practice. People received care and treatment when necessary from their GP and had access to healthcare professionals when required.

A range of in house and community based activities, including work placements were available for people to participate in. People were supported to maintain relationships that were important to them.

The provider had a procedure for receiving and dealing with complaints. Staff spoken with were fully aware of their responsibilities in supporting people if they needed to complain about the service they received. People using the service had access to an advocate.

The service has six single bedrooms, two bathrooms, a spacious kitchen, a laundry a large lounge and a separate dining room. There is a garden to the rear of the property and car parking at the side. At the time of the inspection there were four people living at the service.

The inspection took place on 1November 2016 and was announced. At the last inspection in June 2015, we rated the well led domain as requires improvement as there was no registered manager in place. An acting manager had been appointed, but had not yet registered with the Care Quality Commission (CQC). The registered provider was compliant in each of the other areas we assessed.

At this inspection we found there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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.

We found staff were recruited in a safe way; all checks were in place before they started work and they received a comprehensive induction. Staff received training in how to safeguard people from the risk of harm and abuse. They knew what to do if they had concerns and there were policies and procedures in place to guide them when reporting issues of potential abuse.

Safe systems were in place for the administration, storage and recording of people’s medicines.

The registered manager ensured staff had a clear understanding of people’s support needs, whilst recognising their individual qualities and attributes. Staff were positive about the support they received from their manager.

Records showed people had assessments of their needs and support plans were produced: these showed people and their relatives had been consulted and involved in this process. We observed people received care that was person centred and care plans provided staff with information about how to support people in line with their personal wishes and preferences.

People told us they liked the meals provided and were offered support to prepare their own meals when they wished to do this. Staff supported people with their nutritional and health needs. Staff liaised with health care professionals on people’s behalf if they required support in accessing their GP or other professionals involved in their care.

Risk assessments were completed to guide staff in how to minimise risks and potential harm. Staff took steps to minimise risks to people’s health and wellbeing without taking away people’s rights to make decisions.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support, and what to do if people lacked capacity to agree to it.

There was a complaints procedure in place that was available in a suitable format, enabling people who used the service to access this information if needed.

People told us staff treated them with respect and were kind and caring. Staff demonstrated they understood how to promote people’s independence whilst respecting their privacy and dignity.

We found the environment was accessible and safe for people. Equipment used in the home was regularly serviced and an issue of stained carpets was addressed on the day of inspection.

There was a system of audits and checks in place which identified shortfalls within the service and to rectify them so the quality of care could be maintained and improved. This had proved effective, for example in the development of recording information in a person centred way.

Our inspection team was made up of two adult social care inspectors.

We considered the findings of our inspection to answer the questions we always ask:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and speaking with staff. We also looked at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At this inspection we found the registered provider had made improvements with the records to support the management of behaviours which challenged the service and the use of physical interventions when required. The records we saw showed staff had received more training and people's behaviours were being managed safely and appropriately.

Risk assessments were completed and updated so staff had guidance in how to support people in ways that minimised the risks.

There had been improvements in the way staff were recruited. All employment checks were now completed before staff started work.

There had been improvements in the numbers of staff on duty, which meant there was sufficient staff on duty during the day and night. The number of staff on duty took account of people's care needs.

Improved systems were now in place to ensure the manager and staff learned from events such as incidents, accidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

Improvements had been made to the storage, recording and administration of medicines.

Is the service effective?

At this inspection we found the registered provider had made improvements to ensure people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The care records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met. From our observations and time spent at Emerald House we saw that the people who lived there received the care and support they needed in an individual way and wherever possible staff tried to facilitate choice.

People were asked for their consent prior to care and support and were asked for their views about activities of living on a daily basis. Care records we viewed showed more consideration of the Mental Capacity Act 2005(MCA). Mental capacity assessments were carried out and best interest meetings held when people lacked capacity and important decisions were required.

Records and discussions showed staff had received further training, direction and support which enabled them to be more skilled and confident when supporting people, especially in relation to their behaviour and health care needs.

We spoke with one person who was complimentary about the staff. They told us, 'The staff are great, always around if you need them. They are always friendly, nice and helpful.'

Is the service caring?

We found the service provided a calm and homely environment that enabled people to live an independent lifestyle where possible. We found that staff were understanding of people's individual needs. People's preferences, routines, likes and dislikes had been recorded and care and support was provided in accordance with people's wishes and choices.

People were supported by staff who were attentive, kind and who treated them with dignity. We saw that staff showed encouragement and patience when supporting people.

Is the service responsive?

We observed staff involved people and offered each one choice in regard to their needs. The staff approach to people who used the service was calm, respectful and friendly.

Records showed that where people's needs had changed staff had taken appropriate action to regularly review care plans.

People had access to a range of health and social care professionals such as GPs, psychiatrist, dieticians, speech and language therapists, social workers and dentists. There was evidence the staff team sought appropriate advice, support and guidance both routinely and during emergency situations.

People told us they felt able to complain and make suggestions about the service during meetings and on a day to day basis.

Is the service well-led?

Following the last inspection we were informed that a new manager had been appointed. The new manager has previous experience of managing similar services and is a qualified mental health nurse. The registered provider had also secured additional management support from their other service locations to support the necessary improvement work.

We found improvements had been made to the way the registered provider monitored the quality of the service and the processes to identify, assess and manage risks to people's health, safety and welfare. Incidents were monitored more closely and records showed appropriate action had been taken to protect people's safety and welfare. We found the acting manager had reviewed the audit programme and had completed regular audits in areas which had been highlighted at the last inspection.

We saw there were improved systems in place to monitor people's health and welfare and these systems had been maintained and had influenced the care provided.

We found staff had a better understanding of the ethos of the service. Staff were clearer about their roles and responsibilities and told us the service was much more organised. Staff told us they were well supported by the manager and had supervision meetings. They also said appraisal meetings were being arranged. Staff meetings were held so information could be exchanged and views expressed.

Comments from staff included, 'Everything is more organised now. The records have been updated and are checked regularly. We have all had lots more training and have regular one to one meetings. People are supported in the community. Things are a lot better.'

Records showed the management team had worked with key organisations, staff, people who used the service and their representatives in recent weeks to secure improvement and maintain those standards.

Prior to the inspection we had received a number of whistle blowing concerns and concerns from other regulatory bodies and linked organisations about the safety and welfare of the people who used the service. We decided to bring forward the date of the scheduled inspection. This inspection involved an unannounced visit to the service on 3 June 2014 and included discussion s with people who used the service and members of staff.The inspection gathered evidence against the outcomes we inspected to help answer our five key questions:Is the service caring?Is the service responsive?Is the service safe?Is the service effective?Is the service well led?