This inspection took place on 18 August 2016 and was unannounced. At our last inspection, 11 November 2015, we found the service was meeting the regulations associated with the Health and Social Care Act 2008. However our ratings for all of the key questions were ‘Requires Improvement’. This was because the provider had implemented new systems and processes but these had not been operational for a sufficient amount of time for us to be sure of consistent and sustained good practice. At this inspection we found that these systems were being maintained and evidence of consistent and sustained good practice.

Emmanuel Care Services Limited is a care home which provides care and accommodation for up to three people with learning disabilities and mental health needs. There were two people living at the home at the time of this inspection.

The home had a registered manager in post. The registered manager was also the registered provider. 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.

Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. Risks to people were assessed and care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. People’s medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed training specific to the needs of the people they supported and they received regular supervision and annual appraisals of their work performance. People were provided with sufficient amounts of food and drink to meet their needs and staff knew how to support people with eating and drinking where needed. People had access to a GP and other health care professionals when they needed them. The registered manager had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and acted according to this legislation.

People and their relatives were provided with appropriate information about the home. This ensured they were aware of the standard of care they should expect. People and their relatives, where appropriate, had been involved in planning for their care needs. Relatives were aware of the complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The provider recognised the importance of regularly monitoring the quality of the service provided to people. They sought the views of people using the service through satisfaction surveys and discussed the findings from the surveys at staff meetings. Staff said they enjoyed working at the home and they received good support from the registered manager. There was an out of hours on call system in operation that ensured management support and advice was always available when staff needed it.

This inspection took place on 11 November 2015 and was unannounced. At our previous inspection on 15 and 18 June 2015 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that people’s privacy and confidentiality was not always respected. People were not receiving person centred care that reflected their personal preference. Robust records relating to the management of peoples finances were not being maintained. Appropriate recruitment checks were not being carried out before staff started work at the home and some staff had not received training to enable them to fulfil the requirements of their role. We also found that some records relating to the management of the home were not being maintained and there was no effective system in place to monitor the quality of service people received. We placed the provider in special measures and continued to monitor the service. The provider sent us an action plan on 15 July 2015 telling us what actions they would take to address these breaches.

At this inspection, 11 November 2015, improvements had been made. The provider had moved office equipment and records from the living room to a vacant room. This room was being used as an office and a sleepover room which meant that people using the service could now access the living room in their home freely at all times. The manager had taken steps to increase opportunities for people using the service to access the community and partake in in-house activities. We found there were appropriate systems in place for managing people's money. Appropriate recruitment checks were being carried out before staff started working at the home. The current staff team had completed mandatory training in line with the provider’s policy; they were receiving regular formal supervision and had completed an annual appraisal of their work performance. Records relating to the management of the home and people using the service were being maintained securely. There were systems in place to monitor the quality and safety of the service.

Following our last inspection on 15 and 18 June 2015, we placed the service in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. As the provider has demonstrated improvements and the service is no longer rated as inadequate for any of the five questions, it is no longer in special measures.

Emmanuel Care Services Limited is a care home which provides care and accommodation for up to three people with learning disabilities and mental health needs. There were two people living at the home at the time of this inspection. The provider had plans to extend the building by December 2016. They told us they would continue to use the vacant room as an office until the extension is completed.

The home 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.

At this inspection we also found there were safeguarding adult’s procedures in place and staff understood these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. There were enough staff on duty to meet the needs of people using the service. Risks to people were assessed, reviewed and managed appropriately. People’s medicines were being managed appropriately and they were receiving their medicines as prescribed by health care professionals.

People were provided with sufficient amounts of nutritional foods and drink that met their needs. They were supported to maintain good health and had access to health care support. The manager understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation.

Assessments were undertaken to identify people’s support needs before they moved into the home. Care plans were developed outlining how these needs were to be met. The care files we looked at included care and health needs assessments, care plans and risk assessments. The files also included evidence that people using the service, their relatives, their keyworkers and care managers had been involved in the care planning process where appropriate. This ensured that people received continuity in the delivery of their care and that this was effectively communicated to all persons involved. The home had a complaints procedure in place.

Staff said they enjoyed working at the home and they received good support from the manager. There was an out of hours on call system in operation that ensured that management support and advice was always available to staff when they needed it

We found one of the three people using the service present during our inspection, and they expressed being happy with the care delivered to them. We saw positive interactions between staff and the person using the service, and this person was supported into the local community during our inspection. Another person using the service had attended the daycentre and we were told that the third person only accessed the service as a respite placement mainly on weekends.

At our inspection on 29 July 2013, we followed up compliance and enforcement action that we had taken following our inspection on 30 April 2013. We found that people’s care plans were reflective of their current care needs and care was delivered in line with their care plan. The provider had made progress in ensuring that suitable arrangements were in place to ensure that people using the service were safeguarded against the risk of abuse, and that they were protected against the risks associated with the unsafe use and management of medicines. We found the provider had improved systems in place to assess and monitor the quality of service provision. Professionals such as the social worker we spoke with were happy with the care provided to people using the service and with the improvements that the provider had made.

People using the service told us that they were happy living at the care home and that staff were kind and supported them in meeting their activities of daily living. One of the person's relative told us that the quality of care provided was “alright” and they had no problems with the care delivered to their relation. Another relative told us that staff had kept them involved in the care planning of their family member. Some people had communication needs and we were not able to ascertain their views directly, however we observed that staff did not engage people in daytime activity to promote their wellbeing.

We found that care was not always carried out in the way that had been planned and that care plans did not reflect some of the needs of the people living at the home. Staff we spoke with showed an understanding of the safeguarding of vulnerable adults but the arrangements in place to manage people’s finances were not in accordance with the provider’s own policy and decisions were not made in line with the Mental Capacity Act 2005. Medicines were not appropriately managed and safely given to people. The provider had made maintenance improvements to the safety of the premises. The provider did not have appropriate processes in place to monitor the quality of service being provided against the risks of unsafe care and treatment.

People who used the service told us they were happy living at Emmanuel Care Services Limited. They told us staff were friendly towards them and staff helped them with various aspects of their lives including going shopping and encouraging them to attend community day activities. People also told us staff supported them to maintain their independence by encouraging them to help out around the home, for example by supporting them to cook and clean. They said staff supported them to manage their money and medication, however other evidence did not support this.

People told us they were given choices by staff throughout the day such as what food they would like to eat and the activities they wanted to participate in. One person told us they were able to chose the colour their room was painted. We saw care records that had been agreed by people who used the service which demonstrated people were involved in planning and reviewing their care.

People told us they knew how to complain but they had not had any reason to do this. People told us they were happy with the living environment at the home, however we found the premises was inadequately maintained and work was required to make the home safe and homely for the people who lived there.

This inspection took place on 15 and 18 June 2015 and was unannounced. At a previous inspection of the home on 30 April 2013, we took enforcement action against the provider because we found they needed to make improvements relating to the management of medicines, monitoring the quality of the service and safeguarding people using the service against the risk of abuse. At a follow up inspection on 29 July 2013 we found that improvements had been made and the provider had complied with our enforcement actions.

Emmanuel Care Services Limited is a care home which provides care and accommodation for up to three people with learning disabilities and mental health needs. There were two people living at the home at the time of this inspection.

The home 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.

At this inspection we identified areas of unsafe and poor quality care. This was because the service was not well led. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found that people’s privacy and confidentiality was not always respected. People were not receiving person centred care that reflected their personal preferences in terms of the activities available to them at the home. Robust records relating to the management of peoples finances were not being maintained. Appropriate recruitment checks were not being carried out before staff started work at the home and some staff had not received the training to enable them to fulfil the requirements of their role. We found that some records relating to the management of the home were not being maintained, some records were being secured appropriately and there was no effective system in place to monitor the quality of service people received.

We found there were enough staff on duty to meet people’s needs. People’s medicines were being managed appropriately and they were receiving their medicines as prescribed by health care professionals. They were supported to maintain good health and had access to health care support. People were provided with sufficient amounts of nutritional foods and drink that met their needs. There were safeguarding adult’s procedures in place and staff understood these procedures. The manager understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. We have made a recommendation that the risks to people using the services are recorded individually thus making them easier for staff to understand and follow.

The relatives of people using the service felt their relatives were well cared for and were safe living at the home. Assessments were undertaken to identify people’s support needs before they moved into the home. Care plans were developed outlining how these needs were to be met. People using the service and their relatives had been consulted about their care and support needs. The home had a complaints procedure in place.

Staff said they enjoyed working at the home and they received good support from the manager. There was an out of hours on call system in operation that ensured that management support and advice was always available to staff when they needed it.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.