Archived: Emmanuel House

Emmanuel House provides accommodation for up to two people living with some form of learning disability. The service provides accommodation and support and at the time of this inspection they had one vacancy. The person living at the service had done so for a number of years.

The provider explained they had had some difficulties developing the service due to only having one placement for a number of years. This has placed financial restraints on monies available to run the service and had an impact on the finances available for maintenance, staff training and general development of the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manager 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 person at the service was treated with dignity and respect and staff interacted with them in a kind, caring and sensitive manner. Staff showed a good knowledge of safeguarding procedures and were clear about the actions they would take to protect people.

The service had a small regular and consistent staff team. The provider had appropriate recruitment checks in place which helped to protect people and ensure staff were suitable to work at the service, but no new staff had been employed at the service for a number of years. There were sufficient numbers of skilled, well trained and qualified staff on duty. Staff told us that they felt well supported in their role and could gain advice and support from the registered manager at any time, but formal supervision had not been regularly received. All staff held a recognised qualification in care and had the skills and experience to provide the care required. Due to financial restraints of the service training updates had not been routinely organised and staff required refresher training on the service’s mandatory training.

We found that a detailed assessment had been carried out and that the care plan had been developed around the individual’s needs and preferences. We saw that there were risk assessments in place and plans on how the risks were to be managed. Support was provided to help the person receiving support in taking every day risks and encouraging them to take part in daily activities and outings. Systems were in place to ensure appropriate assessments could be carried out where people living at the service may not be able to make decisions for themselves and to help ensure their rights would be protected.

There were systems to enable people to raise concerns and people could be confident they would be listened to and appropriate action taken.

Medication was well managed and this helped to ensure that the person living at the service received their medication safely and on time. They were also supported to be able to eat and drink sufficient amounts to meet their needs and were offered choice at meal times. We also found that the person had access to a range of healthcare providers, such as their GP, dentists, chiropodists and opticians.

The provider had quality assurance systems in place, but these had not been routinely completed. Systems were in place to enable the person living at the service, their relatives and other health care professionals the opportunity to feedback on their experiences. Staff stated that they involve their present service user in day to day decisions and the running of the service and this practice was observed during our inspection.

Two care workers were spoken with to gain their views about the service. The views of the person presently living at the service were gained with regard to what it was like to live at Emmanuel House and what support they received from the care workers. A family member was also contacted and their views were gained on the service their relative received. Where possible their feedback has been incorporated into this report.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

A family member spoken with confirmed that their relatives were treated with respect and dignity by the care workers and added that they felt their relatives were safe. Safeguarding procedures were in place and care workers spoken with understood how to safeguard the people they supported.

Care workers had been provided with training in safeguarding vulnerable adults from abuse. This meant that staff had been provided with the information they needed to help ensure that people were safeguarded from abuse. The manager had completed training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), so was aware when to make referrals to ensure people were kept safe.

The service had sufficient care workers to provide the care and support needed. The person presently living at the service stated they had regular carer workers who provided support. A family member spoken with stated they had seen an improvement in their relative since living at the service and they now had regular contact and also visited them and took them out. They were confident that their relative received the care they required.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people are protected.

Is the service effective?

Care records showed that care and treatment had been planned and delivered in a way that ensured people's safety and welfare. The records had been regularly reviewed and updated, which meant that care workers had been provided with up to date information about how people's needs were to be met. People living at the service received effective care and support and family members spoken with told us that they had seen an improvement in the dependency levels of their relative since receiving the service.

Is the service caring?

People were supported by kind and attentive staff. Family members spoken with provided positive comments about the care and support their relative received. They confirmed that the service offered their relative choice and involved them in any decisions that needed to be made. People's diversity, preferences, interests and aspirations had been recorded and care and support had been provided in accordance with people's wishes. Care workers had worked at the service for a number of years and those spoken with had a good understanding of people's care needs and how they wished to be supported.

Is the service responsive?

The person living at the service had been supported in participating in activities and daily life skills, and their choices had been taken in to account and they were listened to.

People we spoke with knew how to make a complaint if they were not happy with the service. They added that they were confident their concerns would be listened to and acted upon.

Is the service well-led?

The manager of the service is registered with the Care Quality Commission.

The service worked well with other agencies and services to make sure those living at the service received continuity of care. There were clear lines of accountability and systems in place for people to raise any concerns they may have had.

Management were presently looking at ways to gain feedback about their service and had started to develop a pictorial questionnaire to be given to people who lived there. They were also looking at ways of gaining feedback from other professionals who work with the service.

The service had some quality assurance systems in place, but the management were still in the process of developing these.

Care workers stated that they had found the service well led. They added that the management were very approachable and supportive. One added that the management were good at supporting the staff if they needed advice or help.

We found that the provider had arrangements in place for recording consent. We saw the person was asked for their consent before support was given.

We found that since our inspection in February 2013 the provider's arrangements for assessing and planning people's care and treatment had improved. We saw the person's care and treatment was planned and reviewed with their involvement. Risks to the person's health, welfare and safety were identified and managed. Our latest inspection showed us that the service was generally safe and caring.

We saw that the provider cooperated with other providers involved in the person's care in order to ensure that appropriate care planning took place.

We found that although some of the necessary maintenance had been completed since our inspection in February 2013, the provider did not have a robust system in place for highlighting repairs and ensuring that repairs were carried out in a timely manner.

We found that there were sufficient numbers of suitably trained staff.

We found that the provider was unable to promptly locate records relating to the management of the service. Staff were unable to access the latest information on the person's support needs, and some relevant information regarding the running of the service.

We saw that people's needs were assessed and care provided according to their needs although some complex needs had not been addressed to manage comfort and safety.

We found the premises had not been maintained adequately which meant that people were at physical risk and at risk from poor hygiene.

Staff had appropriate checks before being employed and had adequate training and supervision.