The inspection of EAM House commenced on the 18 October 2017 and was unannounced. The inspection was prompted due to concerns received from both Trafford and Rochdale local authorities in relation to a specific incident that occurred at the home. The information shared with CQC about the incident indicated potential concerns about the management of risk in relation to the recruitment and training of staff and the impact these may have on the people who use the service This inspection examined those risks.
We last inspected EAM House on 6, 7 and 12 September 2016 when we rated the home ‘Requires Improvement’ overall. At that inspection we found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, recruitment, need for consent, good governance and staff training. We served requirement notices to the provider to formally inform them of the reasons they were in breach of the regulations and to tell them improvements must be made.
EAM House is registered to provide residential and nursing care to children and young people, from birth up to the age of 18 years, with complex health needs. The service also provides short breaks care (respite), which is planned or emergency care provided to a person in order to provide temporary relief to family members who are caring for that person. The home can accommodate up to eight persons at a time. At the time of this inspection, there were three young people living at the home.
The service is located in a large detached house within its own grounds. On the ground floor, there is the kitchen, large lounge and dining area which leads into a conservatory that looks out onto well maintained and accessible gardens, greenhouse, and outdoor seating areas. The service has a sensory room on the premises which is separate from the main building.
The service has a registered manager who has been registered with the Care Quality Commission (CQC) since July 2011. 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.
Staff were supported to complete a nationally recognised qualification in health and social care. However we found new staff were not always provided with the necessary training to enable them to undertake their role safely as soon as they joined the service. The registered manager acknowledged there were gaps in staff supervisions and appraisals as the provider employed a consultant to work develop this area.
At the last inspection in September 2016 we noted that the yellow clinical waste bin located in the courtyard at the back of the premises was not locked. At this inspection we found the yellow clinical waste bin was again unlocked, and close to the back door of the home there was a yellow bag that contained clinical waste. The provider had not taken reasonable steps to ensure the clinical waste was stored securely.
We noted there were a number of quality audits in the service; these included medicines, care records and health and safety. Actions were identified following the audits, however, we found the provider had not done enough to ensure training provided to staff was undertaken in a timely manner as we found a number of essential training topics had not been completed.
We saw that care plans reflected how people liked to receive their care. Care plans were detailed and included information about what was important to people and how best to support them. However, we found one person’s care plan did not detail how staff needed to identify and manage deterioration in the person’s health. This area was also highlighted as part of Trafford commissioning action plan, which identified further training would be provided by Trafford around the care of deteriorating people, to ensure the staff team escalated matters of concern in a timely manner.
At the last inspection we found robust recruitment processes had not been followed. At this inspection we found improvements had been made to ensure the provider followed a process when undertaking recruitment checks. However, we found the provider had not safely ensured a staff member received a work place risk assessment and a robust induction to establish that they were competent in their role as a nurse. As a result, this staff member was involved in a serious incident that occurred at the home and is currently being reviewed further by CQC.
The home did not have a call bell system and was not using assistive technologies such as pressure/movement sensors to detect or help prevent falls, or seizure monitors. To manage risks in these areas, staff completed 10 minute checks. However, use of assistive technologies in some cases may have been less intrusive.
Systems were in place to help ensure people's health and nutritional needs were met. Records we reviewed showed that staff contacted relevant health professionals to help ensure people received the care and treatment they required.
We saw that there were positive relationships between people who lived at the home and had a good understanding of people's individual care and support needs. A variety of activities were provided to meet people's individual needs, and people were encouraged to take part.
We observed that people’s privacy and dignity was observed and there were kind and sensitive interactions between care staff and people when they were providing direct care. However the home did not have a call bell system and was not using assistive technologies such as seizure monitors or pressure/movement sensors to detect and help prevent falls. The registered manager commented that staff undertook 10 minute checks during the night to check on people’s conditions. However, we found this approach had not considered people’s privacy and the use of assistive technologies in some cases may have been less intrusive.
Staff understood people's individual communication styles, and were able to communicate effectively with them. People's permission was sought before any care or support was given. Time was taken to make sure that people could make choices and decisions about the care and support they received.
We observed an open and friendly culture at EAM House in which people’s relatives or representatives had the opportunity to provide feedback about the service in an informal way. Everyone we spoke with said they could talk to the staff or registered manager if they needed to.
We found the service was working within the principles of the Mental Capacity Act (2005). Best interest meetings and capacity assessments were held where required. Applications for Deprivation of Liberty Safeguards (DoLS) were appropriately made. However, we found some staff were not aware of the key principles of the mental capacity act.
People received their medicines in a safe and timely way. Staff followed advice given by professionals to make sure people received the care they needed. However, we found room temperatures were not being recorded in people’s bedrooms of where the medicines were securely stored. A maximum/minimum thermometer should be placed in all rooms where medicines are stored and the temperature of the room monitored on a daily basis (preferably at the same time each day) to ensure that medicines stored in the room are stored within the recommended limit.
We found three breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of full version of this report.