Archived: Emmanuel Care Home

Emmanuel Care Home is registered to provide accommodation for persons who require nursing or personal care for a maximum of 37 people. The conditions of registration were recently changed by the registered provider when the service stopped providing nursing care. As a result the service now provides care for older people and people living with dementia, but does not provide nursing care. There were 28 people using the service at the time of this inspection.

The service is situated in a quiet residential area of Hessle on the outskirts of the city of Kingston-Upon-Hull and consists of a large traditional house with a modern extension to the rear of the property. There is a car park on site for visitors. All bedrooms are now used for single occupancy and some have en-suite toilet facilities.

The registered provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been in post for the last six months. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager had recently been interviewed following their application to become the registered manager and was awaiting the outcome.

At this inspection the registered provider had made sufficient improvements to show they were no longer in breach of any of the regulations and had met the recommendations we made. The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Refurbishments had taken place and an on-going programme of maintenance continued so that eventually all of the premises would be upgraded and redecorated.

The dining experience had improved for people and they received adequate nutrition and hydration to maintain their health and wellbeing.

A new activities coordinator was now employed and people had the opportunity to engage in some pastimes and activities if they wished to in order to pass the time of day. Activities were usually designed to stimulate the brain, keep skills going and stretch the imagination.

There was an effective system in place for checking the quality of the service using audits, satisfaction surveys, meetings and good communication. Improvements in systems were made to ensure they effectively checked people’s experience of the care they received and relatives were satisfied with the quality of care provided.

People were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were managed and reduced on an individual and group basis so that people avoided injury, harm or abuse.

Staffing numbers were sufficient to meet people’s needs and we saw that rosters accurately reflected the staff that were on duty. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for vulnerable people. The management of medicines was safely carried out and infection control practices were safe.

People were cared for and supported by qualified and competent staff that were regularly supervised and appraised regarding their personal performance. People’s mental capacity was appropriately assessed and their rights were protected. Staff had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves. The registered manager ensured legislation was appropriately used to reach decisions made in people’s best interests where they lacked capacity.

The premises were suitable for providing care to older people and those living with dementia. We were told that additional work was planned to further improve the environment (provide activities and occupation) so that it was entirely suitable to meet the needs of those living with dementia.

We found that people received compassionate care from kind staff. People were supplied with information relevant to their needs, were involved in all aspects of their care and were always asked for their consent before staff undertook care and support tasks.

People’s wellbeing, privacy, dignity and independence were monitored and respected. This ensured people were satisfied and enabled to take control of their lives.

People were supported according to their person-centred care plans, which were regularly reviewed. People had very good family connections and support networks.

There was an effective complaint procedure in place and people had complaints investigated without bias. People that used the service, relatives and their friends were encouraged to maintain healthy relationships through frequent visits, telephone calls and sharing of information.

The service was well-led and people had the benefit of a culture and management style that was positive and inclusive.

People had opportunities to make their views known through formal complaint and quality monitoring formats. People were assured that recording systems used in the service protected their privacy and confidentiality, as records were well maintained and were held securely in the premises.

What people told us and what we found

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? 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 using the service, their relatives and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During our visit to Emmanuel, we checked the premises and found it provided a safe and suitable environment.

Before anyone received care from the service, pre-admission information was obtained and assessments of people's individual needs took place. This meant the staff knew how to care for the people who used the service.

We saw that risks associated with people care were assessed and action was taken to reduce the effect of those risks.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards exist to ensure people are only deprived of their rights if it is within their best interests. DoLS where deemed necessary had been submitted, and the deputy manager understood the home's responsibilities under the Mental Capacity Act 2005 and following a recent court ruling regarding DoLS in care settings had arranged to attend a meeting with the local authority to discuss the new requirements.

Is the service effective?

Assessments had been carried out on each person pre and post admission and these had been used to inform the care plans.

Each person had individual care plans which were up to date and set out their specific needs and people had been involved in the assessment and planning of their care.

Staff we spoke with were knowledgeable about the people who used the service and could describe to us their individual needs and likes.

Is the service caring?

People were supported by caring and knowledgeable staff and we saw that care records were accurate and up to date.

The assessment, planning and delivery of care and support was centred on the individual and considered all aspects of their individual circumstances.

People said they were happy with the care they received. One person told us the staff 'are caring and fun to be around'

Is the service responsive?

People had access to a range of specialists and health professionals to ensure they received appropriate care.

Records showed that people and their relatives were involved in determining what care they needed.

People told us they had never made a complaint but knew how to if they were unhappy about anything. One person mentioned 'I can even tell them [the staff] off and they listen to me'.

Is the service well-led?

The provider gathered information about the quality of their service from a variety of sources. Care records, including care plans and charts, were regularly reviewed.

Staff meetings were held to keep staff up to date with new information.

Regular checks of the premises took place to ensure it was safe and suitable for the people who lived there.

You can see our judgements on the front page of this report

You can see our judgements on the front page of this report.

Our brief chats with people at this inspection indicated they were happy in the service and from what we observed people were settled and relaxed with the staff and other service users.

We found that improvements had been made with regards to record keeping. However, the manager told us that they appreciated further work had to be done to complete the rewriting of all of the care plans and associated care records in order to sustain these improvements.

We found people were being looked after by friendly, supportive staff within a warm and homely environment. People who spoke with us said 'The staff really look after us' and 'I couldn't wish for better people to look after me. Nothing is too much trouble for them.'

People were supported to be able to eat and drink sufficient amounts to meet their needs. People who spoke with us were very complimentary about the meals and said the food was lovely.

We saw that there were sufficient numbers of staff on duty to meet the needs of the people who used the service. One person told us, 'Staff are friendly and give us the support and help we need' and another said 'There is a lovely atmosphere in the home, very friendly and welcoming.'

The service had a staff induction and training programme, which meant the staff received professional development and support.

The provider had an effective quality assurance system in place and people's views and opinions of the service were listened to and acted on where necessary.

We found that the care plans did not always contain sufficient written information about people's specific care needs and the support being offered by the staff to meet their needs. However, our observations of the service and discussion with people and staff indicated that appropriate care was being delivered.

We spoke with two people who used the service. They enjoyed living in the home and were very positive about the care they received and the service. One person said 'The care is very good; staff couldn't do more for us. I like living here in the home.'

We also spoke with three relatives who told us 'The staff are friendly, supportive and professional' and 'There is a lovely atmosphere in the home, very friendly and welcoming.'

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity and kept personal information confidential.

People said that they had good access to outside healthcare professionals and they were satisfied with the level of medical support given to them. One relative told us 'I cannot believe how X's health has improved since they came into the home. X has put weight on and I am very happy and satisfied with their care.'