Emmanuel Care Services Limited

About the service

Emmanuel Care Services Limited is a residential care home providing personal care to up to two people at the time of the inspection. The service can support up to three people. The service support people with a learning disability, autistic people and people with mental health needs.

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

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture

Right Support

The service supported people to have the maximum possible choice, control and independence over their own lives. People were supported by staff to pursue their interests. Staff supported people to take part in activities and pursue their interests in their local area. Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. People could take part in activities and pursue interests that were tailored to them. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, including advocates and professionals, were involved in planning their care. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (published 14 February 2020). We carried out an unannounced comprehensive inspection of this service on 19 December 2019. Breaches of legal requirements were found.

The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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.

Emmanuel Care Services Limited is a care home which provides care and accommodation for up to three people with learning disabilities and mental health needs. At the time of this 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

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

However, specific risks were not assessed with appropriate risk management plans in place to reduce or prevent the risk occurring. The systems in place to assess and monitor the quality of the service were not always effective in driving improvement and did not identify the shortfalls we found at our inspection. There was not enough activity of interest which were socially relevant and stimulating to people’s needs.

We have given a recommendation about supporting people with stimulating activities.

People received care and support that was personalised to their need and felt safe living at the home. Medicines were managed safely, and people were protected from the risk of infections. There was enough staff available to support people safely and the service followed safe recruitment processes. Accident and incidents were reported and recorded, and any lessons learnt were used to improve on the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The home environment was improved to ensure the design and decoration was meeting people’s needs.

Before people started using the service their needs were assessed to ensure they could be met. Staff received support through induction, training and supervision to ensure they performed their roles effectively. People were supported to maintain good health, eat sufficient amounts of food for their health and wellbeing and access healthcare services.

Staff supported people in a caring way and their privacy and dignity was maintained. People’s diversities and rights were respected, and they were involved in making decisions about their care and support needs. People’s independence was promoted and they were encouraged to perform chores they had the capacity do.

People were supported to maintain relationships important to them. People’s communication needs had been assessed and met. People and their relatives told us they knew how to make a complaint but there had not been a reason to do so.

The management team demonstrated a commitment to provide high quality care and knew they had to be honest, transparent and open when things went wrong. People’s views were sought to improve the quality of the service. The service worked in partnership with key organisations and health and social care professionals to deliver an effective service. Staff knew of their individual responsibilities, they told us they felt supported in their role and were happy working at the home

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

Rating at last inspection:

The last rating for this service was requires improvement (4 July 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 7 March 2019. Breaches of legal requirements were found, and a warning notice served on 16 May 2019 for the breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this comprehensive inspection to check the service had followed their action plan and to confirm they now met legal requirements.

Enforcement

We have identified breaches in relation to risk management and effective systems for monitoring the quality of the service.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support because of the promotion of choice and control, independence and inclusion.

However, people were not always supported with person centred care including the support to communicate effectively and develop their skills through activities. People did not always experience care and support with dignity and respect and were not always referred to by their preferred names.

Risk to people and their health and safety was not always identified, assessed and had appropriate management plans in place to manage risks safely. Medicines were not stored safely with appropriate records maintained. People were not always supported to live in a clean and safe environment. Cleaning products were not always stored within the requirements of Control of Substances Hazardous to Health (COSHH).

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

The systems in place to assess, monitor and improve the quality of the service and to drive improvement was ineffective. Staff knew how to recognise abuse, report abuse and protect people from abuse and neglect.

People were supported to maintain good health, eat healthily and access healthcare services where required. People and their relatives were involved in making decisions about their care and support needs and their privacy and dignity was respected, and their independence promoted.

The provider had a policy and procedure on how to make a complaint; however, no one had made a complaint since our last inspection in August 2016. Relatives told us they knew how to make a complaint if they were unhappy.

No one using the service required end of life care and support; however, there were systems in place to ensure that people had access to end of life care when required.

Feedback from people, their relatives and staff was used to develop the service. The service worked in partnership with key organisations to ensure people’s needs were met. Staff said they enjoyed working at the home and felt supported in their role.

Rating at last inspection: Good (Last report published 18 August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection, we identified breaches in regulations.

Enforcement: Please see other ‘actions we have told the provider to take' section towards the end of the report.

Full information about CQC's regulatory response to the more serious concerns found in inspections is added to reports after any representations and appeals have been concluded.

Follow up: This service will be kept under review and where necessary another inspection will be conducted within a further six months. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme.

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

Emmanuel Care Services Limited is a care home which provides care and accommodation for up to three people with learning disabilities and mental health needs. There were two people living at the home at the time of this inspection.

The home had a registered manager in post. The registered manager was also the registered provider. 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.

Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. Risks to people were assessed and care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. People’s medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed training specific to the needs of the people they supported and they received regular supervision and annual appraisals of their work performance. People were provided with sufficient amounts of food and drink to meet their needs and staff knew how to support people with eating and drinking where needed. People had access to a GP and other health care professionals when they needed them. The registered manager had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and acted according to this legislation.

People and their relatives were provided with appropriate information about the home. This ensured they were aware of the standard of care they should expect. People and their relatives, where appropriate, had been involved in planning for their care needs. Relatives were aware of the complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The provider recognised the importance of regularly monitoring the quality of the service provided to people. They sought the views of people using the service through satisfaction surveys and discussed the findings from the surveys at staff meetings. Staff said they enjoyed working at the home and they received good support from the registered manager. There was an out of hours on call system in operation that ensured management support and advice was always available when staff needed it.

At our inspection on 29 July 2013, we followed up compliance and enforcement action that we had taken following our inspection on 30 April 2013. We found that people's care plans were reflective of their current care needs and care was delivered in line with their care plan. The provider had made progress in ensuring that suitable arrangements were in place to ensure that people using the service were safeguarded against the risk of abuse, and that they were protected against the risks associated with the unsafe use and management of medicines. We found the provider had improved systems in place to assess and monitor the quality of service provision. Professionals such as the social worker we spoke with were happy with the care provided to people using the service and with the improvements that the provider had made.

We found that care was not always carried out in the way that had been planned and that care plans did not reflect some of the needs of the people living at the home. Staff we spoke with showed an understanding of the safeguarding of vulnerable adults but the arrangements in place to manage people's finances were not in accordance with the provider's own policy and decisions were not made in line with the Mental Capacity Act 2005. Medicines were not appropriately managed and safely given to people. The provider had made maintenance improvements to the safety of the premises. The provider did not have appropriate processes in place to monitor the quality of service being provided against the risks of unsafe care and treatment.

People told us they were given choices by staff throughout the day such as what food they would like to eat and the activities they wanted to participate in. One person told us they were able to chose the colour their room was painted. We saw care records that had been agreed by people who used the service which demonstrated people were involved in planning and reviewing their care.

People told us they knew how to complain but they had not had any reason to do this. People told us they were happy with the living environment at the home, however we found the premises was inadequately maintained and work was required to make the home safe and homely for the people who lived there.