Archived: EAM Lodge (Trafford) Also known as Number 46

We last inspected EAM Lodge on 18 and 19 October 2017. At that time, we rated the service requires improvement overall and identified breaches of regulations in relation to safe care and treatment and staff training. We also made two recommendations in relation to assessing people’s needs in relation to the use of assistive technologies, and assessing the safety of the premises and equipment.

At this inspection we found the provider had taken action and had made improvements in relation to all the previous breaches and recommendations. The provider was found to be meeting the requirements of all regulations.

EAM Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

EAM Lodge accommodates up to five people in one adapted building. The service provides care, including nursing care to young adults who have a learning disability and/or complex heath care needs. The home provides support to people staying at the home for short breaks (respite), as well people who live at the home on a longer-term basis. At the time of our inspection there were three people living at the home on a permanent basis, and two rooms were available to people staying for short breaks. There was one person staying at the service for a short break on the first day of our inspection.

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 was a registered manager who was registered to manage the service in September 2016. The registered manager intended to step down from this position in the future, but told us they would continue in the role until the provider could find a suitable replacement. The day to day management of the home had also been supported by the registered manager working at the neighbouring service, EAM House.

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.

There were sufficient staff on duty to enable staff to meet people’s needs. We saw staffing levels were varied dependent on the needs of people using the service. The registered manager also considered the skill-mix of the staff team when deploying staff.

We saw any accidents and incidents were thoroughly investigated, and steps were taken to help prevent a repeat incident and to make the service safer. There was an open and honest culture, and the provider encouraged staff to reflect on how they could have done things differently when they went wrong. Lessons were learned from any incidents and this resulted in improvements being made within the service.

The registered manager and staff team demonstrated a commitment and enthusiasm for delivering quality, person-centred support. The service did not use agency staff, which helped the service provide consistent care from staff that knew people well.

Staff were kind, caring and respectful in their approach. Staff had developed close relationships with people using the service. They had a good understanding of people’s needs and preferences. We observed people smiling and laughing with staff and they appeared relaxed and comfortable when receiving support.

Staff received the training and support they needed to meet people’s needs effectively. The provider checked staff were competent to provide the care and support people needed.

Staff provided opportunities for people to engage in a range of activities that met their needs and preferences. People were supported to access the local community and community groups. Some people had been supported to attend events of interest to them such as music concerts and the rugby.

The service worked alongside a range of health and social care professionals in order to meet people’s needs. We saw staff had developed detailed care plans that were updated as people’s needs changed. Care plans reflected people’s needs and preferences in relation to how their care was provided.

Relatives told us staff communicated well with them. They told us they would feel confident to raise a complaint if they had any concerns.

There were systems in place to help the registered manager and provider monitor the quality and safety of the service.

Staff understood the principles of the mental capacity act, and we saw evidence of good practice in relation to completion of capacity assessments and best-interest decisions. However, as at our last inspection, some consent forms had been signed by others when there was no evidence that they had authority to provide consent on that person’s behalf.

The provider sought and acted on the views of people using the service or their representatives. They considered and acted on feedback received from relevant persons such as the CQC and the coroner.

The coroner had issued a prevention of future deaths report in April 2018 following the inquest of a child who had died when staying at the neighbouring service, EAM House in July 2016. This was relevant to this inspection because of shared processes, staff and management teams between the two services. However, we found the provider had acted on all the concerns raised in the coroner’s report to make improvements at both services. We have reported in more detail on this issue in our report for EAM House published in October 2018.

EAM Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

EAM Lodge accommodates up to five people in one adapted building. The service provides care, including nursing care to young adults who have a learning disability and/or complex heath care needs. The home provides support to people staying at the home for short breaks (respite), as well people who live at the home on a longer term basis. At the time of our inspection there were four people living at the home on a long term basis, and one room was available to people staying for a short break.

This was the first inspection of EAM Lodge (Number 46) since the service’s registration with the Care Quality Commission (CQC) in September 2016. At this inspection we identified two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to training and providing safe care and treatment. You can see what action we have told the provider to take at the back of the full version of this report.

We have made two recommendations. These relate to reviewing good practice guidance and advice in relation to: Assessing people’s needs in relation to the use of assistive technologies and assessing the safety of the premises and equipment.

EAM Lodge had a ‘homely’ feel that was commented on by both relatives of people using the service and staff. Staff knew the people living at or supported by the service well and had developed positive, caring relationships with them.

Staff were aware of people’s care needs and preferences. They communicated effectively with people and involved them in decisions about their care as far as was possible. People’s relatives told us they were involved in planning their family member’s care when this was appropriate. They told us the service were good at keeping them informed about any changes to the care their family member received.

People were supported to engage in a range of activities at home and in the local community. Staff had considered how they could support people to maintain and develop relationships with peers, family and others.

Staff assessed risks to people’s health and wellbeing and were aware of plans in place to reduce risks. However, some risk assessments, such as those in relation to the use of bedrails, were generic and had not considered risks that could be unique to each individual.

We found there were sufficient numbers of staff on duty to meet people’s needs. Prior to our inspection, concerns had been raised with CQC and the local authority in relation to the practice of having one member of nursing staff on a sleep-in shift to cover both EAM Lodge and the neighbouring service, EAM House. Whilst this arrangement had been put in place out of necessity due to difficulties recruiting nursing staff, we were satisfied the provider had considered how to ensure this arrangement was safe.

Competent persons completed regular servicing and inspection of the premises and equipment. We found the provider was in the process of completing outstanding actions identified in their fire risk assessment completed in October 2016.

Staff were not monitoring people’s weights on a regular basis where this would be required to ensure they received the correct nutritional support. This was in part due to the service not having scales to weigh people with limited mobility. We also found the home had no back-up suction machine in case of breakdown. Whilst the service was able to obtain a same-day replacement, the risk of this potential delay had not been considered.

Staff told us they received sufficient training to feel they were able to undertake their job roles and meet people’s assessed needs. We saw training in a wide range of topics had been completed and staff’s competence to carry out care tasks had been assessed. However, there were gaps in training such as epilepsy, learning disability awareness, the mental capacity act and behaviours that challenge. We also found evidence that staff had not followed good practice in relation to supporting people with behaviours that could challenge the service.

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. To manage risks in these areas, staff completed regular, recorded 10 minute checks. However, use of assistive technologies in some cases may have been less intrusive.

Care plans were detailed and person centred. They contained information about people’s preferences as to how they received their care. Staff were aware of these details.

The service had a registered manager in post. 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 felt well supported by the registered manager and colleagues at the service. We found staff received regular supervision and feedback on their performance. Staff were also able to discuss any concerns they might have at staff meetings.

The registered manager completed a variety of checks and audits to help monitor the safety and quality of the service. However, the medicines audit was limited in scope. The provider had not ensured that staff training in key areas was kept up to date and in some instances, complete records of care provided had not been maintained.