Archived: Emerton Close

Updated 29 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Before the inspection, we looked at all the information we held about the service. This information included the statutory notifications that the service sent to the Care Quality Commission. A notification is information about important events that the service is required to send us by law. We asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Due to technical problems a PIR was not available and we took this into account when we inspected the service and made the judgements in this report. We also contacted health and social care professionals and the local authority safeguarding team for feedback about the service. We used this information to help inform our inspection planning.

This inspection took place on 18 and 19 October 2017 and was unannounced. The service was inspected by two adult social care inspectors and an expert by experience accompanied the inspectors on 19 October 2017. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

During the inspection we spoke with one person who used the service, as the other nine people did not communicate verbally so we spent time observing them. We also spoke with three relatives, seven members of staff, the acting manager, the area manager, and three visiting health and social care professionals. We looked at six people’s care records and seven staff records. We also looked at records related to the management of the service such as details about the administration of medicines, complaints, accidents and incidents, safeguarding, Deprivation of Liberty Safeguards, health and safety, and quality assurance.

Updated 29 December 2017

This announced inspection took place on 18 and 19 October 2017. 1-3 Emerton Close provides accommodation for people who require nursing or personal care for up to 10 adults who have a range of needs including learning disabilities. 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 were 10 people across three separate units, each of which have separate adapted facilities at the time of our inspection.

At our previous inspection on 23 and 25 November 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We found some aspects of the arrangements for the safe management of medicines for people using the service were not robust. The provider had not taken timely action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. Some aspects of the quality assurance systems were not effective. Following that inspection the provider sent us an action plan showing how they planned to make improvements.

At this inspection we found that the provider had made improvements. Relatives commented positively about staff and the service. Staff felt supported by the acting manager. The service had worked effectively in partnership with health and social care professionals. Visiting health and social care professional spoke positively about the service and the staff. The service had made improvements in the systems used by the provider to assess and monitor the quality of the care people received. These included regular residents meeting, staff meetings, area manager’s audits and acting manager’s checks. As a result of these checks the service made improvements.

Although the provider had made improvements since the November 2016 inspection, at this inspection we identified some further improvement was required in specific areas of medicines recording and audits. Whilst there were safeguards in place Medicines administration record (MAR) were not completed correctly. Some of the PRN (as required) medicine protocols did not have sufficient information included for staff to ensure that they were only given when they were required. The medicines audit carried out in the house had not identified the issues we have found.

In response to the inspection feedback, the area manager told us that they would oversee all the future checks carried out by the acting manager and revalidate them to avoid any errors.

The above issues were a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we have asked the provider to take at the back of the full version of this report.

People had received their medicines as prescribed. We observed a medicines round and found that staff followed safe procedures of administration medicines and completed the medicines administration records (MAR) charts. Staff received medicines management training and their competency was checked. All medicines were stored safely. The liquid medicines were labelled and dated when opened. However, we saw there was an inconsistent approach to medicines recording within the service and this required improvement.

Records showed that appropriate referrals had been made, and authorisations granted by the relevant ‘Supervisory Body’ to ensure people’s freedoms were not unduly restricted. The provider had completed the monitoring forms for the ‘Supervisory Body’ in line with the conditions they had placed on people’s DoLS authorisations.

The service did not have a registered manager in post. The previous registered manager left the service in July 2017. In the interim, the service had the deputy manager working in the capacity of an acting manager, supported by the provider’s another home’s registered manager for two days a week and by the area service manager for two days a week. The area service manager told us that the provider’s other home registered manager would be a full time manager for Emerton close from January 2018 and that they had already made an application to CQC to become a registered manager.

Relatives of people who use the service told us they felt safe and that staff and the manager treated their loved ones' well. The service had clear procedures to support staff to recognise and respond to abuse. The acting manager and staff completed safeguarding training.

Staff completed risk assessments for every person who used the service which were up to date and included detailed guidance for staff to reduce risks. There was an effective system to manage accidents and incidents, and to reduce the likelihood of them happening again. The service had arrangements in place to deal with emergencies.

People’s consent was sought before care was provided. The service had worked with their relatives, if appropriate, and the relevant health and social care professionals in making decisions for them in their best interests and had maintained a record to reflect the same in line with the MCA.

The service provided an induction and training, and supported staff through regular supervision and annual appraisal to help them undertake their role. The service had enough staff to support people and carried out satisfactory background checks of staff before they started working. Staff felt supported by the provider.

The area manager told us the service used staff induction and training to explain their values to staff. We observed people and staff were comfortable approaching the acting manager and their conversations were friendly and open.

Staff assessed people's nutritional needs and supported them to have a balanced diet. Staff supported people to access the healthcare services they required and monitored their healthcare appointments.

Staff involved relatives of people who used the service in day to day life of their loved ones. Staff considered people's choices, health and social care needs, and their general wellbeing.

Staff supported people in a way which was kind, respectful and encouraged them to maintain their independence. Staff also protected people's privacy and dignity, and human rights.

The service supported people to take part in a range of activities in support of their need for social interaction and stimulation. The service had a clear policy and procedure about managing complaints. Relatives knew how to complain and told us they would do so if necessary.