Inspection on 29/03/10 for Emmanuel Care Services Ltd

This is the latest available inspection report for this service, carried out on 29th March 2010.

CQC found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Emmanuel Care Services Ltd 16/04/08

Emmanuel Care Services Ltd 25/05/07

Emmanuel Care Services Ltd 02/05/06

Emmanuel Care Services Ltd 06/12/05

Emmanuel Care Services Ltd 13/06/05

Extracts from inspection reports are licensed from CQC, this page was updated on 17/07/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Emmanuel Care Services Ltd 33 Disraeli Close Thamesmead SE28 8AP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Halliwell     Date: 2 9 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Emmanuel Care Services Ltd 33 Disraeli Close Thamesmead SE28 8AP 02083109340 02083109340 careemmanuel@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Remi Konan Name of registered manager (if applicable) Mrs Remi Konan Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability Code LD Date of last inspection Brief description of the care home Emmanuel Care Services was registered in February 2005 to provide care for up to three adults with learning disabilities. The provider of the home is also the manager. The home is located in a three-storey semi-detached town house in central Thamesmead. A bus service connects with the town centre and local facilities. There is one single bedroom on the ground floor and two further single bedrooms on the second floor. None of the bedrooms are en-suite but all of the bedrooms have a hand washbasin. There is a lounge and kitchen/diner on the first floor, a bathroom with shower and toilet on the second floor and a toilet on the ground floor. There is a small, Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 3 2 0 0 4 2 0 0 9 Brief description of the care home enclosed paved garden at the rear of the property. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The stars quality rating for this service is 2 stars. This means that people who use these services experience good quality outcomes. Service users said that they like to be called residents. No enforcement activity has occurred with this service. This was an unannounced inspection visit and was carried out over a day. The Inspection covered all the key standards in the National Minimum Standards. The inspection involved a review of all the agencies records and a formal interview with the Manager and with a support worker. We had discussions with the resident. Both staffing files and the residents file were inspected as well as the policies and procedures manual for the home. Care Homes for Adults (18-65 years) Page 6 of 33 1 new requirement and 1 repeated requirement and 4 recommendations have been made as a result of this inspection. Feedback on both the requirement and the recommendations was given verbally to the Manager at the end of the inspection visit. The Manager and staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The homes Registration Certificate with the Commission was seen displayed appropriately in the main office. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Areas identified at this inspection that need some improvement are as follows: Standard 1 It is recommended that the Manager ensures that the list of services provided in the SOP and SUG includes information about longer stay residents and respite care. Standard 20 It is a requirement that all staff are given training for the safe administration of medicines so that continuity of care can be maintained during holidays or sudden illness. Standard 23 It is recommended that the Manager ensures the other member of staff receives this training as soon as possible and preferably from L.B.Greenwich an authorized training facility. Standard 35 It is recommended that the Manager ensures that all staff are asked to review the key policies and procedures for the home at the induction stage and then when policies and procedures are updated in the future these should be discussed individually with each member of staff in their supervision sessions. They should then sign to say that for each individual key policy and procedure that they have read and understood it and had the chance to discuss it with their supervisor. Standard 39 It is recommended that the Manager should ensure that the current residents views are sought for quality assurance purposes to do with different aspects of the home and their relatives and other professional views should also be sought. This is important so as to ensure the home continues to run with the residents views underpinning the management and running of the home. Standard 39 It is required that one of the Directors or Partners must carry out regular unannounced Care Homes for Adults (18-65 years) Page 8 of 33 visits to assess the conduct of the service. This is a repeated requirement and unless the new timescale is met enforcement action may well be taken. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1 & 2 were inspected. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available to help prospective residents and their representatives make an informed choice about whether to use the service. People have an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. Evidence: Standard 1 We read the Statement of Purpose (SOP)and the Service User Guide (SUG) and these contain information that people receive about Emmanuel Care Services when considering whether they want to live there. The content provides information about the aims and objectives of the home. It tells people what support with day to day needs, social, leisure and educational opportunities and the environment they can Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: expect to receive. It is recommended that the Manager ensures that the list of services provided in the SOP and SUG includes information about longer stay residents and respite care. The service user guide includes information about the complaints procedure so that residents have this information to hand should they need it. Prospective service users have the information they need to make an informed choice about whether they wish to live here or not. Standard 2 Suitable policies are in place to ensure that the home only admits people whose needs can be met by the services provided at Emmanuel Care Services. We were however not able to assess the arrangements for admitting new people to the home as the home had not admitted any new service users in the period since the last inspection. Inspection of the residents care file who is living in this home indicated that an assessment of needs had been completed by both the referring clinical teams and by the home. We saw that this assessment has been regularly evaluated and updated. This shows that peoples needs will be monitored and reviewed. This means that prospective service users individual aspirations and needs will be assessed. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 6, 7 & 9 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents may be assured that their assessed needs and personal goals will be reflected in their care plans. They may also be assured that they will be able to make decisions about their daily lives and be enabled to take risks as part of developing a more independent lifestyle with support, as they need it. Evidence: Standard 6 We examined the care records for the resident living at this home. The file included an individualised care plan to address the persons health, social and personal care needs and information for staff about how potential risks should be managed. Care plans about the management of challenging behaviour had been updated to include information about signs that might indicate an individual is becoming agitated Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: and what staff can do to help the person calm down. The key worker completes a monthly report. The report provides information about significant events, appointments and issues that had occurred since the last review. The report provides useful information about service users health and wellbeing. This all means that residents know their assessed and changing needs and personal goals are reflected in their care plans. Standard 7 The Manager told us that staff work hard to enable a resident to make decisions about their lives and that they provide assistance as it is needed. We saw that the resident living at this home had some involvement in their needs assessment and care planning and we were told by that resident who we spoke to that they are involved and encouraged to make their own decisions. The Manager told us that there are regular monthly house meetings with residents and that relevant issues are discussed concerning all aspects of life in the home and in relation to individual needs. We saw minutes of these meetings that evidenced this statement. The Manager told us that the current residents finances are managed by their family and that the home is not involved in this process. This all means that residents are enabled to make decisions about their lives with assistance as needed. Standard 9 The person living at Emmanuel is known to have challenging behaviour. The Manager had assessed the risk of people being harmed and recorded guidance for staff about the action they should take to protect themselves and other people. The assessments that we saw included checking the residents mood prior to any outings, asking him to sit in the middle seat in the back of the car so that they could not make contact with the driver or open the doors and guidance about how to approach the service user. Risk assessments were updated when other professionals provided new information or advice or when the needs of the resident change. There are good systems in place for monitoring their physical well being and care plans are reviewed to ensure that staff take further action to meet resident support needs. This all means that residents are being supported to take risks as a part of developing a more independent life style. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 15, 16 & 17 were inspected at this inspection. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents are able to take part in age and culturally appropriate activities and are to a reasonable extent involved in local activities. Residents have appropriate relationships and their rights and responsibilities in their daily lives are recognised and respected by the staff in the unit. Residents are offered a healthy, varied and nutritious diet. Evidence: Standards 12 & 13 Records and observation showed that residents are offered choices of activities and are supported to engage in their preferred interests and hobbies. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: Activity plans are flexible so that daily programmes can alter if residents wish to do something different. The current resident told us that they like to go out and some of the community activities mentioned included bowling, basketball, walking and shopping. The Manager told us that due to this residents particular needs he is unable to go out on his own and so is always accompanied by staff. The Manager also told us about some of the activities that are offered in house to the residents. This included entertainment facilities such as television, videos, a music system, art and craft activities and jigsaws, computer and board games. When we spoke to the resident he told us that he enjoys going out to church every Sunday and that staff are supportive and helpful to enable him to do so. Meetings were held monthly for the residents when 3 people were living at this home. Minutes showed that residents have opportunities for discussing and planning activities. It was clear that their views have an influence on the way the activities and outings are organised and the way the home is run. This all means that residents are able to take part in age and culturally appropriate activities and that where they want to be residents may enjoy being a part of the local community. Standard 15 The Manager told us that residents do keep in regular contact with their families and friends. This resident sees his family at weekends. We were told that staff encourage the residents to keep and maintain contacts with family and friends so that residents benefit from having appropriate relationships. Standard 16 Policies seen by us to be established within the unit ensure that residents rights to privacy, respect and dignity are respected. When we spoke to the resident he confirmed that he felt staff respected these rights. The Manager told us that residents may have a key to their own bedrooms if they wish. We observed staff to be interacting with residents in a friendly and respectful manner. Standard 17 With regards to meals and meal times there is a planned and varied 4 week menu and we saw the planned menu for the week ahead. The food choices selected show that a nutritional range of food is offered to residents. The Manager told us that specific needs can be catered for and alternative choices are provided. Due to Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: current circumstances of there only being one resident currently in placement at this home the Manager said that the resident is able to state his preferences almost on a daily basis. When we spoke to this person he told us that he enjoys the food that is provided for him. The Manager told us that the home does not use a dietician in assisting with the menus but that if there was need they would do so. This all means that residents are offered a healthy diet and that they enjoy their meals and mealtimes. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 18, 19, & 20 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the homes policies and procedures for dealing with medicines. Evidence: Standard 18 The Manager explained that generally residents can choose when they get up each morning. The resident we spoke to at this inspection said that he does choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. The resident that we spoke to did not raise any concerns with us about their key Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: worker in fact their comments reflected a positive view of key work support. This means that residents receive personal support in the way they prefer and require. The Manager said that residents at Emmanuel Care continue to receive regular input from their Community Psychiatric Nurses and from other professionals in their clinical teams. We saw daily diary sheets that provide adequate information about the type and level of support that the resident receives to maintain their personal care. Standard 19 The Manager told us that all of the people that live in the home are registered with a local GP and are supported to attend appointments and meetings. Records show that the current resident had seen a variety of different health care professionals including a dentist, optician, chiropodist, a specialist community nurse, psychiatrist and was also supported to attend hospital appointments for scans and tests. This all means that residents physical and emotional health needs are being met. Standard 20 As a part of this inspection we examined the medication charts. All of the information recorded on the charts was hand written by a staff member and countersigned by a second member of staff. This practice reduces the risk of errors. Records were kept about medicines that were received in the home. Medicines were stored in a small room under the stairs. There was no surface in the room to place medicines pots or medication administration charts on but the manager said staff could use the top of the filing cabinet for this purpose. The home did not have any drugs that require special storage facilities and had stopped using homely remedy medicines. The homes medication procedure must be reviewed and amended to reflect this change. The Manager is a registered nurse. She told us that she is the only member of staff that administers medicines in the home. At the last inspection a recommendation was made that some of the other staff are trained and assessed to undertake this task so that continuity of care can be maintained during holidays or sudden illness. This is now a requirement. We did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 18, 19, & 20 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the homes policies and procedures for dealing with medicines. Evidence: Standard 18 The Manager explained that generally residents can choose when they get up each morning. The resident we spoke to at this inspection said that he does choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. The resident that we spoke to did not raise any concerns with us about their key worker in fact their comments reflected a positive view of key work support. This means that residents receive personal support in the way they prefer and require. The Manager said that residents at Emmanuel Care continue to receive regular input Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: from their Community Psychiatric Nurses and from other professionals in their clinical teams. We saw daily diary sheets that provide adequate information about the type and level of support that the resident receives to maintain their personal care. Standard 19 The Manage told us that all of the people that live in the home are registered with a local GP and are supported to attend appointments and meetings. Records show that the current resident had seen a variety of different health care professionals including a dentist, optician, chiropodist, a specialist community nurse, psychiatrist and was also supported to attend hospital appointments for scans and tests. This all means that residents physical and emotional health needs are being met. Standard 20 As a part of this inspection we examined the medication charts. All of the information recorded on the charts was hand written by a staff member and countersigned by a second member of staff. This practice reduces the risk of errors. Records were kept about medicines that were received in the home. Medicines were stored in a small room under the stairs. There was no surface in the room to place medicines pots or medication administration charts on but the manager said staff could use the top of the filing cabinet for this purpose. The home did not have any drugs that require special storage facilities and had stopped using homely remedy medicines. The homes medication procedure must be reviewed and amended to reflect this change. The Manager is a registered nurse. She told us that she is the only member of staff that administers medicines in the home. At the last inspection a recommendation was made that some of the other staff are trained and assessed to undertake this task so that continuity of care can be maintained during holidays or sudden illness. This recommendation is repeated. We did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate. Care Homes for Adults (18-65 years) Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 24 & 30 were inspected. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents at Emmanuel Care live in a homely, comfortable and safe environment. The home is also clean and hygienic. Evidence: Standard 24 The home is located in a three storey town house, on a housing estate in Thamesmead. There is a local bus service and various shops within walking distance of the home. As a part of this inspection we looked at all areas of the home to assess the quality of the environment and decor. This home is reasonably well decorated and maintained and made comfortable with homely communal spaces. Since the last inspection some upgrades have been made so that the decor, fixtures and fittings are in good order with furniture to suit residents needs. We were shown by the residents their bedroom. It was adequately furnished and comfortable however we would recommend that it is more personalized so that it Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: reflects the individual lifestyle, interests and tastes of the resident concerned. General maintenance throughout the home was seen to be reasonable and evidently an improvement from the last inspection. The home was seen to be clean and no odours were noted. This means that residents do live in a homely and comfortable environment. Standard 30 The home has an infection control procedure in place. A review of the homes staffing files and other training information indicated that both members of staff have received training to do with infection control in 2008 and 2010 respectively. This is seen as important so that staff know the required standards and what measures and controls need to be in place to achieve the standards. There is not a laundry room in this home as it is run as a family home. The laundry facilities are situated in the kitchen and the Manager told us that this was recommended by environmental health As has already been stated, at the time of this inspection the home was seen to be clean and tidy, hygienic and free from offensive odours. Systems are in place to ensure that the spread of infection is controlled and minimised. Care Homes for Adults (18-65 years) Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 32, 34, 35 & 36 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff. Staff are being provided with the necessary induction and training with which to competently perform their work duties. They are being protected and kept safe by the use of appropriate recruitment policy and procedures. Records are being maintained as required. Staff are also supervised appropriately and this also benefits residents in terms of the support they receive. Evidence: Standard 32 The Manager showed us certificated evidence that all of the staff that work in the home had a vocational qualification in care at level two or above. Staff interviewed confirmed that they hold their NVQ qualifications. Due to the current lack of new residents the Manager told us that no new staff had been recruited since the last inspection. We looked at the 2 staff members files to see if the home carried out adequate pre employment checks and obtained copies of important documents. The file included an application form and employment history, two written references that were company stamped or on headed note paper, proof of Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: identification, a recent photograph, a statement about the persons physical and mental health and an enhanced criminal record disclosure. The applicant was interviewed and notes were kept about their suitability for the role. The member of staff who we spoke to had completed health and safety, safeguarding adults, physical intervention, challenging behaviour, medication, handling and fire safety training sessions in the period since the last inspection. Staff said the challenging behaviour session was particularly relevant and helpful. Copies of certificates were kept as proof of training. It is recommended that the Manager develops a training matrix so that she can see at a glance what training updates staff require. This all means that residents are supported by competent and suitably qualified staff. Standard 34 Inspection of the records show that Emmanuel Care does have in place appropriate polices and procedures. The staff files were checked at this inspection. These contained all of the required legal checks and documentation which shows that the home takes care to recruit staff correctly. Two references were on each file, a completed CRB check, health declaration, proof of identity and records of interview notes. Employment contracts were seen on each of the staff files we inspected. All this helps to ensure that the well being, health and security of service users is being protected by the agencies policies and procedures on recruitment and selection of staff. Standard 35 The Manager told that there is a programme of induction for all new staff. This covers staff roles and responsibilities, and key policies and procedures. Induction is ongoing for up to 4 - 6 weeks with observation and shadowing from an experienced staff member and ongoing assessment. The Manager told us that the staff induction training does include fire, manual handling, food hygiene and health and safety. With regards to staff competency it is important that all staff are familiar with the homes policies and procedures. It is therefore recommended that the Manager ensures that all staff are asked to review the key policies and procedures for the home at the induction stage and then when policies and procedures are updated in the future these will be discussed individually with each member of staff in their supervision sessions. They should then sign to say that for each individual key policy and procedure that they have read and understood it and had the chance to discuss it with their supervisor. The Manager explained that there is an good training programme provided for staff and certificated evidence was seen on the staffing files inspected that confirmed these staff had attended the following training courses: 1. Medication administration, 2. 1st Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: Aid, 3. Infection control, 4. Health and safety, 5. Fire safety, 6. Manual handling, 7. Food hygiene, 8. POVA, 9. Effective communication, 10. Risk assessment, 11. Challenging behaviour, 12. Epilepsy 13. Mental Capacity Act 14. Dealing with complaints Staff who we spoke to said they found the training useful in helping them to undertake their roles in the home more effectively. This all means that residents individual needs are being met by appropriately trained staff. Standard 36 We also inspected the staff files in relation to staff supervision and records were seen to show that this takes place on a regular basis. Staff interviewed said that their supervision happens every 6 - 8 weeks. Staff are asked to sign their supervision records as was evidenced by the inspection of these records and staff confirmed that they find this support very helpful and that they are given a copy of the minutes for their information. Staff spoken to said that the following issues are discussed at their supervision sessions as a standard format: Key work with residents Training needs Personal issues. Staff told us that they felt well supported in the home and felt that the management team were helpful when they had concerns or problems arising in their work. Residents should be able to benefit from well supported and supervised staff. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service is well managed. The home provides a stable environment where people are listened to, they feel safe and their views are respected. Evidence: Standard 37 The Manager explained that they became the registered manager for the service in 2005. She holds a National Higher Certificate in Care, a Batchelor of Arts in Social Care and became a registered mental health nurse in 2008. The Manager completed some distance learning training courses in the period since the last inspection. Staff told us that the Manager was supportive and approachable. They said that if there was a crisis or emergency the manager always returned to the home and maintained regular telephone contact with staff when she was off duty. We saw evidence of this during the inspection. This means that residents benefit from a well run home. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: Standard 39 When the home was full the Manager had introduced a quarterly check to assess staff performance and to monitor the management of specific issues such as complaints. Service users views were obtained during residents meetings, but this was often limited as some of the service users have difficulty communicating. With only one person currently residing at this home the process of using questionnaires for service users, relatives, advocates and visiting health and social care professionals to obtain their views about the service is more difficult. However it is recommended that the Manager should still ensure that this persons views are sought to do with different aspects of the home and their relatives and other professional views should also be sought. This is important so as to ensure the home continues to run with the residents views underpinning the management and running of the home. One of the Directors or Partners must carry out regular unannounced visits to assess the conduct of the service. This is a repeated requirement and unless the new timescale is met enforcement action may well be taken. When these issues have been embedded it will means that residents can be confident their views underpin all self monitoring, review and development undertaken by the home. Standard 42 A fire risk assessment was carried out in 2008 and 2009 by the Manager and a fire emergency plan in place. The LFEPA visited in 2009 and found the homes fire arrangements satisfactory. The Manager told us that new staff will receive some training at induction to do with the homes fire equipment and fire safety; food hygiene and infection control. Certificates were seen by us for the following services that are installed in the home, certificates which state that these systems have been checked by appropriate professionals since the last inspection were found to be satisfactory and fit for purpose. 1. Boiler / gas 25.8.09 2. Electrical system check 13.4.08 3. Fire alarms 1.9.09 4. Emergency lighting system 1.9.09 5. Fire fighting equipment 1.9.09 6. Portable electrical equipment 13.8.09 Inspection of the fridges and freezers in the home showed us that food is being appropriately stored, labelled and dated. We were shown records that indicate fridge and freezer temperatures are being recorded appropriately. The building was seen to have appropriate security measures in place and at the time of this inspection there were no fire doors wedged open. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: This all means that the health, safety and welfare of residents and staff are being promoted and protected. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 39 26 Regulation 26 visits must be carried out regularly and a written report about the conduct of the service must be completed. To assess the conduct of the service and to help identify areas for improvement. 14/08/2009 Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 It is a requirement that all staff are given training for the safe administration of medicines so that continuity of care can be maintained during holidays or sudden illness. In order to meet the NMS. 01/06/2010 2 39 10 It is required that one of the 01/06/2010 Directors or Partners must carry out regular unannounced visits to assess the conduct of the service. This is a repeated requirement and unless the new timescale is met enforcement action may well be taken. In order to meet the NMS. Care Homes for Adults (18-65 years) Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 It is recommended that the Manager ensures that the list of services provided in the SOP and SUG includes information about longer stay residents and respite care. It is recommended that the Manager ensures that all staff receive POVA training as soon as possible and preferably from L.B.Greenwich an authorized training facility. It is recommended that the Manager ensures that all staff are asked to review the key policies and procedures for the home at the induction stage and then when policies and procedures are updated in the future these should be discussed individually with each member of staff in their supervision sessions. They should then sign to say that for each individual key policy and procedure that they have read and understood it and had the chance to discuss it with their supervisor. It is recommended that the Manager should ensure that the current residents views are sought for quality assurance purposes to do with different aspects of the home and their relatives and other professional views should also be sought. This is important so as to ensure the home continues to run with the residents views underpinning the management and running of the home. 2 23 3 35 4 39 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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