The inspection of EAM House commenced on the 20 June 2018 and was unannounced. We last inspected EAM House in October 2017 and rated the service ‘Requires Improvement’ overall. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment, premises and good governance. We served requirement notices for the breaches of regulation relating to safe care and treatment and premises. We took enforcement action and served a warning notice in relation to breach of the regulation of good governance. In March 2018, the provider asked to meet with the Care Quality Commission (CQC) to discuss the actions they had taken following the inspection in October 2017 and improvements made to the quality of care and support provided.

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 stor

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 wo

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. Our inspection took place on 6, 7 and 12 September 2016 and the first day was unannounced.

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 interaction

On the day of our inspection there were seven children living in EAM house, three were permanent and four on respite. We spent time observing staff interacting with the children and young people and observed positive interactions, and clear understanding of the children’s individual communication and personal preferences.

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.

During our inspection of EAM House we found care was given in a professional manner by trained and knowledgeable staff. We saw people using the service were happy and supported in their activities.

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

Due to the nature of the service provided we were unable to gain comments from people who used the service. Our judgements were based on speaking with staff and observation of care and treatment during the site visit.