Sunflower House

EAM House is a care home providing personal and nursing care to five young adults with a learning disability or autism and 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. Due to the COVID-19 pandemic the respite service was not being offered at the time of our inspection. The home can accommodate up to eight people at a time.

The service is located in a large detached house within its own grounds. All bedrooms are single with communal bathrooms, lounge and dining areas. A conservatory that looks out onto well maintained and accessible gardens. The service has a sensory room on the premises which is separate from the main building.

People’s experience of using this service and what we found

Relatives were positive about the support provided by EAM House. They said the staff team met the complex health needs of their relatives and the communication with the home was good. Relatives were involved in the planning of their relative's care and support.

Person centred care plans and risk assessments provided guidance for the support people required, including when they may become agitated. These were reviewed each month. People received their medicines as prescribed.

Staff said they enjoyed working at EAM House, saying the management team were approachable and supportive. There were enough staff on duty and they received the training and support needed to meet people’s assessed needs. Staff were safely recruited.

The staff team worked in partnership with other professionals, including social workers, medical professionals and the community learning disability team. People’s health and nutritional needs were being met.

The home was clean throughout and the current government COVID-19 guidelines were being followed.

A quality assurance system was in place, with actions taken where issues were found. Incidents were recorded and reviewed to reduce the chance of a re-occurrence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Staff knew people’s needs well and sort new activities people could participate in within their local community. Care and support plans were person-centred. Staff knew how to promote people’s privacy dignity and independence. Communication with people’s relatives was good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 19 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection was brought forward in part following the outcome of a coronial investigation, concluded in March 2018. Coronial investigations (or inquests) are undertaken to determine the cause or manner of a person’s death. The coroner identified concerns around processes to manage serious incidents, training and competence of staff and insufficient action following recent CQC inspections. At this inspection, we found the provider’s response was satisfactory and the actions taken had been assessed as effective.

EAM House 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. The service also provides short breaks care (respite), which is planned or emergency care provided to a person to give temporary relief to family members, guardians or foster parents who are caring for that person.

EAM House can accommodate up to eight people with complex health needs between the ages of 16 and 60 years in one adapted building.

At the time of this inspection, there were four young people living at the home on a permanent basis and two people who received regular respite care.

The service had a registered manager who has been registered with the CQC since July 2011. A registered manager is a person who has registered with the CQC 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. In June 2018, the provider had employed a care manager who was in the process of registering with CQC to replace the existing registered manager at the home.

Recruitment processes had improved, and we found staff employed had the relevant skills and competencies to carry out their role. However, in the records of a newly recruited staff member, we found documentation contained insufficient information to explain how the provider had assessed risks. This meant we were not sufficiently assured appropriate measures were in place to keep people safe from harm at all times.

The provider had taken reasonable steps to ensure the premises were safe and free from risk of infection. Concerns found at our last inspection in October 2017 regarding the security of the external clinical waste bin and how clinical waste was disposed of had been rectified. Issues identified at the last infection control audit carried out by the NHS infection control lead had been addressed. Staff had good infection control practice such as wearing appropriate personal protective equipment. This meant people were protected from risk of infection contamination.

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. Where medicines were stored in people’s bedrooms, adequate improvements were made in how temperatures were recorded and monitored. This helped to ensure medicines were safe and effective because they were stored at the right temperatures.

Staff received an induction, had relevant training and shadowed experienced colleagues prior to working unsupervised. Since our last inspection in October 2017, required competencies and the use of equipment were reassessed to help ensure staff supported people safely and effectively. Records showed staff had regular supervisions and annual appraisals. This helped to ensure staff were competent and had adequate professional support to carry out their roles.

We found the provider had made sufficient improvements in how they monitored the standard of care provided. These included a better oversight of staff training and competency checks, audits of medicines, care records and health and safety processes and equipment. Actions identified had been followed up.

Care plans reflected how people had been assessed and preferred to receive their care. They were detailed and included information about what was important to people and how best to support them. Improvements had been made in relation to how staff identified and managed deterioration in the person’s health.

People were effectively supported and their privacy and dignity were respected because the provider had considered the use of assistive technologies. At this inspection we found, where appropriate, the provider had implemented the use of relevant assistive technologies. This helped to ensure risks to people were effectively managed while ensuring care and support provided was 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 staff 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.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). The registered manager and staff had a good understanding of MCA. Where a person lacked capacity to make a decision relating to their care or support, a capacity assessment was carried out and best interest meetings were held where required. Applications for Deprivation of Liberty Safeguards (DoLS) were appropriately made. This helped to ensure people’s rights were protected.

People had good relationships with the staff and management at the service. Staff understood the complex needs of the people living at the care home and were able to communicate effectively with them. This meant people were supported by staff who knew their characteristics and individual requirements. People's permission was sought before any care or support was given. Staff supported people in an unhurried and dignified manner, taking time to ensure people could make choices and decisions about the 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.

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.

The previous inspection took place October 2013 and we found at this time that the service had met all regulatory requirements.

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 respite care, 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 five young people living at the service, two of whom where away on holiday. There were also two young people staying at the home on a respite basis.

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. During our visit this room was not being used. The matron nurse and one of the administrative staff members told us the room was due to be cleaned up and should be ready again for use in the autumn and winter months. There are five bedrooms on the first floor and three on the first floor. Also on the first floor, is a toilet/shower room, the laundry and a small bedroom used by sleep-in nursing staff.

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.

We found 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 the report.

Relatives told us the service was safe and we observed that people were at ease with staff and settled at the service. We found the service needed a more robust system of learning from the outcomes of fire evacuation drills undertaken to help ensure that young people were kept safe at all times. There were PEEPS in place however these were generic and did not always contain all relevant information to safely evacuate people from the premises.

We found appropriate health and safety checks for the environment and equipment were done and up to date. Staff were able to explain types of abuse and how they would protect young people from abuse. We were unable to tell if all staff had received training in safeguarding principles. The registered manager told us they were awaiting information from the local authority about this training.

Staffing levels were sufficient for the number of people living at EAM House during our inspection. This meant that people’s needs were safely and effectively catered for. We found the recruitment process could to be more robust, for example, unexplained gaps in employment history and unverified references. This meant the service was at risk of employing staff who were unfit to work with this vulnerable group.

We saw that the provider ensured that induction and mandatory training was completed before staff started in their caring role. This meant that staff were skilled in meeting the needs of the children and young people at the service.

Young people developed good relationships with the staff and management at the service. We observed many instances of good rapport and positive interactions between people and staff and visiting relatives. We saw that staff understood the complex needs of the young people living at the service. This meant people were supported by staff who knew their characteristics and individual requirements.

Support plans were detailed and person-centred, and contained specific information about how each individual should be cared for and supported. This meant staff had clear and specific guidance on how best to support that person. The service operated a key worker system which meant that each person had a member of staff who was responsible for talking to them about their care needs and wishes including social needs, dietary preferences and medication. There were various activities done at the home such as crafts and outings into the community; these were being reviewed by the newly appointed activities coordinator. This should help to ensure that young people were involved in activities that improved their quality of life and maintained links within their community.

People told us the manager and staff were accommodating and helpful. We found the atmosphere at the home to be open and welcoming. We noted the home’s system of record keeping, quality checks and auditing needed to be more robust. This should help management have better oversight of operations and help to drive improvements within service. The provider had developed a set of policies and procedures to help guide staff in their caring role. We saw that staff were encouraged to read and sign these as required. Staff meetings were held and we saw that staff were able to raise service specific issues and training within this forum. This meant that staff were supported by management to do their caring role more effectively.

We spoke to two relatives who told us: 'One word. Perfect. There are so many little things they do which make such a difference, I have lots of respect for all the staff, their interactions are second to none. While X was in hospital, staff visited every day without fail and interacted with X. They all go above and beyond.' 'Without the staff things would have been really difficult, they were fantastic when X first moved in. There is a wonderful atmosphere and X is happy.'

We looked at two care records. We saw people's personal preferences, likes and dislikes had been clearly recorded throughout.

Children's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

The two sets of relatives we spoke with told us they were happy with the care their children were receiving at EAM House.