Emerald Training and Medical Staffing

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

We found the provider to be in breach of 2 legal regulations in relation to safe care and treatment and recruitment.

This service scored 50 (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 have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice. Effective processes were not in place to ensure effective oversight of accidents and incidents. Incident and action log forms were completed by staff which detailed the incident and actions taken in response to the incident, including notifying relevant healthcare professionals. However, there was no accident and incident file in place to ensure incidents were monitored appropriately and that there was effective oversight. Incidents had not been analysed to identify any themes and lessons learnt to improve safety at the service and continually identify and embed good practices.

For example, records showed a number of incidents in relation to behaviours that challenged. However, there was no analysis undertaken and themes identified to help mitigate the risk and, if possible, enable a potential reduction in the number of these incidents occurring at the service.

The registered manager was not always aware of their regulatory responsibilities to notify the CQC and submission of statutory notifications of any significant events at the service. We spoke to the registered manager who told us they would ensure CQC and relevant healthcare professionals were notified of any incidents when they occurred. Records show that notifications have now been submitted to CQC as required.

The provider worked with people and healthcare partners to establish and maintain systems of care. Processes were in place for staff to contact and access health and social care professionals when people needed support with their care and treatment.

The provider worked with people and healthcare partners to understand what being safe meant. The registered manager told us there had been no safeguarding concerns. However, there was no safeguarding file in place to ensure any safeguarding concerns were recorded and there was effective oversight and learning of concerns raised to help protect people from abuse. The registered manager told us they would ensure this is put in place.

Safeguarding and whistleblowing policies were in place. Staff had completed safeguarding training and were aware of how to recognise and report potential abuse.

The provider did not work well with people to understand and manage risks. Risk assessments were not always in place or lacked sufficient detail on how to minimise risks and maintain people’s safety in accordance with people’s specific needs.

Risk assessments in place covered areas such as challenging behaviours displayed whilst out in the community, self-harm, alcohol/substance misuse and mental health. However, despite identifying the risks, there was a lack of information detailing the risk or mitigation in place to reduce the risk.

For example, for 1 person, the risk assessment detailed the person could display challenging behaviour whilst out in the community, the level of risk was assessed as medium, however there was limited information detailing measures in place to reduce the risk and maintain the person’s safety whilst out in the community.

Care records for this person, also showed they used an inhaler, however there was no risk assessment in place to ensure this was being managed safely.

The risk assessment for another person identified risks in relation to not taking their medicines, not attending healthcare appointments and the use of the internet. However, there was limited information detailing the support they would require from staff to attend their appointments, ensure they were taking their medicines and internet usage was safe. Care records also stated the person would often abscond but there was no risk assessment in place for this.

People were able to have intimate relationships if they wished to do so. However, care records contained limited information detailing the support people needed in relation to this and risks assessed to ensure people's rights and welfare were protected.

Care records for people using the service stated they were at risk of neglect in relation to personal care and hygiene. However, there was no risk assessment in place detailing the risks and support required by staff to help mitigate self-neglect in these areas.

The provider did not always detect and control potential risks in the care environment. Environmental risk assessments had been undertaken to help ensure risks within the environment were assessed. Health and safety checks were carried out in respect of the environment and that equipment was safe for use. During the visit to the supported living service, we observed the service had steep stairs and parts of the back garden were also steep which could present a falls hazard. The registered manager told us they were in the process of adding rails in the garden for additional support to help mitigate the risk of falls and had updated the home risk assessment to include these areas and ensure risk was managed in a safe way.

We found the premises were clean and tidy. However, we noted and discussed with the registered manager the décor of the service in communal areas contained basic furnishing and was tired looking. The decor was bland with no bright colours or pictures and lacked a welcoming and inclusive social space and environment that would encourage and develop people’s independent living skills and well-being. After the site visit, the registered manager took action to improve some of the décor of the communal areas.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. Effective recruitment processes were not established and operated effectively to ensure staff were of good character and had the necessary qualifications, competence, skills and experience necessary for their roles. We reviewed 5 staff files.

The interview forms for all 5 staff, although numerically scored, did not detail the questions used and answers provided by applicants and these sections were blank. There was no information which showed how staff had been assessed and confirmed as being suitable and competent for the roles applied for.

In all the staff files, we found full education and employment histories had not been listed and satisfactory written explanation of gaps in employment and education.

We could not be assured of the quality and accuracy of references acquired which verified the employment history, skills and conduct in previous roles. For example, for 2 staff members, references were received from volunteering companies that were not detailed in their employment histories. For another staff member, a character reference was received which was not detailed in the application form and reasons why a character reference would be required. All the references obtained did not contain any company headed correspondence to demonstrate authenticity of any previous organisations worked for.

For 2 staff members, a job offer was made before ensuring they were of good character. For example, a staff member was offered a job on the 7/5/23, however a Disclosure and Barring Service (DBS) check was completed on the 19/7/23. For another staff member, they were offered a job on the 20/2/23, however a DBS check was completed on the 1/3/23. For 3 staff members, DBS checks were from different employers that were not detailed in their employment histories. For all staff members, there were no reasons recorded as to why a full DBS check could not be obtained and potential risks assessed for this.

The provider did not always assess or manage the risk of infection. Staff had received infection control training. During our visit to the supported living service, the premises were generally clean, however the kitchen area was not kept clean and hygienic. We raised this with the registered manager who took immediate action to address and rectified this during the assessment.

The provider did not always make sure that medicines and treatments were safe. Medicines records did not always accurately reflect the support people received. Therefore, we cannot be assured that people received their medicines as prescribed.

We reviewed the medicines administration records (MAR) for 3 people. For 1 person, the MAR sheet showed multiple gaps without explanation. A medicine was prescribed to be given twice a day, however the MARs showed occasions when this was administered only once. For example, on the 6/10/2025, the medicine was only administered at 13.55pm. On the 10/10/2025, the medicine was administered at 18.45pm and on the 28/10/2025 at 12.30pm. There was no further explanation detailing any reasons for this.

Another person required the use of an inhaler two times a day, however the MAR sheet showed occasions when this was either given once a day or not at all.

The MAR sheet also showed the person took ‘as and when required’ medicines (PRN). However, there was no PRN guidance which showed when, how much and what circumstances this was to be given. When the PRN medicine had been administered, the MAR sheets did not detail the reasons why the medicine had been administered. The MAR sheet also showed the medicine was consistently administered on every other day and not as and when required.

Medicines audits were carried out to ensure any discrepancies and/or gaps in recording on people’s MARs were identified and followed up. However, these had not been effective as they did not identify the shortfalls we found at this assessment.

Staff had received medicines training and a medicines policy was in place. However, medicines competency assessments were not in place which demonstrated staff were competent and administered medicines safely.