Emerald Training and Medical Staffing

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

We found the provider to be in breach of 1 legal regulation in relation to need for consent.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check people’s health, care, wellbeing and communication needs. Assessments of people’s needs were carried out prior to people joining the service to ensure their care needs could be met. During the assessments, expected outcomes for people’s care were identified and were used to develop people’s care plans. However, people’s care plans did not fully reflect people’s health needs and conditions and how people should be supported safely to ensure people received care or treatment that had the best possible outcomes.

The provider did not always plan and deliver people’s care and treatment with them. Arrangements to support people with their eating and drinking were not robust. Therefore, people were at risk of not receiving the appropriate support in accordance with their individual nutritional and hydrational needs.

Care records contained limited information and guidance on people’s dietary needs and individual preferences and how people were to be supported with their food and drink. Care records contained generic statements such as ‘Staff to support [person] with cooking nutritious balanced meals’ and ‘[Person] requires support with meal planning and cooking.’ However, there was no further information detailing what support the person required and how this was to be done.

During the visit to the supported living service, we observed a lack of food and drink at the service. Although people would often eat whilst out in the community, there was a lack of staple and nutritious foods, such as fruit and vegetables, available should people wish to have a snack or a meal when they returned to the service. Some of the food in the fridge and freezer was inedible. It was difficult to differentiate which food and drink belonged to each person. Some parts of the kitchen area, cupboards and fridge/freezer appliances were unclean due to grime and needed cleaning. We raised this with the registered manager who took prompt actions to address this. The registered manager ensured the kitchen area was immediately cleaned including disposing the inedible food. A range of food was made available, and a cleaning schedule was put in place to help ensure the area was clean at all times.

The provider did not always work well across teams to support people. Staff worked collaboratively with each other to support people with their needs. Information in relation to people’s needs and any changes with their care were shared through daily handovers with staff. A staff member told us “It is good working here and the environment is good with the service users. There is good teamwork and we work well together.”

However, a robust process was not in place to regularly review and monitor staff performance. Staff files did not contain records of regular supervision, appraisal and spot checks.

Staff had not completed the Care Certificate which is the benchmark that has been set for the induction standard for people working in care. After the site visit, the registered manager told us they had now registered staff to complete the Care Certificate and this was in progress. Records showed staff completed training the provider considered mandatory in areas such as safeguarding, moving and handling and infection control.

The provider did not always support people to manage their health and wellbeing. People were supported to access healthcare services when required. The registered manager worked in partnership with other services such as the GP, community mental health teams and local authorities.

However, care records lacked information about people’s appointments attended, their outcomes and any follow up if required which meant there was a lack of effective oversight of people’s healthcare. Hospital passports were not in place which provided information on people’s needs and the support they required to ensure continuity of care when using different services. We raised this with the registered manager who took prompt action to address this. The registered manager provided an example of a table of appointments to be added to people’s records to ensure ongoing monitoring and oversight. The registered manager also put in place hospital passports for people to use when accessing healthcare services.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. Care records lacked information on people’s needs and outcomes of their care and treatment. Therefore, we could not be assured there was effective oversight with monitoring outcomes of people’s care and that outcomes improved and were consistent.

For example, the care plan for 1 person stated to support the person to access training and education opportunities. However, there was no further information which showed how this was to be done. Care records also showed, the person had applied for a job but was unsuccessful, however there was no follow up to this.

For another person, the care plan stated staff to support them with positive behaviour sessions through key worker sessions. A key worker is a staff member who has key responsibility for a person at the service to address any concerns and issues arising from a person’s care and can focus on a person’s individual needs, wishes and requirements. However, no key workers sessions were in place. A staff member told us people would often decline to have key worker sessions, but they would speak to people and have conversations when needed, however these were not documented.

We did note people had experienced some positive outcomes with their care and treatment, such as being supported to use alternative approaches to substance misuse which people were actively engaged with in a positive way towards their betterment and quality of life.

The provider did not involve people about their rights around consent. Effective systems and processes were not in place to ensure the service acted in accordance with the provisions of Mental Capacity Act (MCA) 2005 and peoples’ best interests were protected. Care records contained limited information about a person’s mental capacity and levels of comprehension. For example, in one person’s care records, it stated ‘[Person] has poor perception of their risks, memory alertness is medium’ with no further details of the person’s capacity. If a person lacked capacity in any areas, there were no records to demonstrate that mental capacity assessments had been undertaken and the best interest decision making process was followed, which would include involving relatives and healthcare professionals. Care records had not been signed by people or where appropriate, their family representatives to indicate that they had consented to their care.

There were MCA policies in place and staff had received MCA training. Staff told us they sought people’s consent before supporting them with their care and treatment.