The inspection was carried out on 8 August 2018 and was unannounced. This meant the provider and staff did not know we would be visiting.

Emyvale House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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 was previously inspected in August 2017 and was rated requires improvement. We found there were three breaches of the regulations. These referred to shortfalls in risks of unsafe care and treatment, medicines, quality assurance and staffing. We asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well-Led.

Emyvale House is situated in West Melton close to the village of Wath-Upon-Dearne, which is approximately six miles from the town of Rotherham. The home provides care for up to16 older people. Bedroom facilities are provided on the ground, first and second floor levels of the building. Access to the first and second floor is by a lift. There are communal areas including a lounge, small conservatory and a separate dining area. There is a small car park at the front of the building and a small enclosed garden to the rear. At the time of this inspection, nine people Lived at Emyvale House.

A registered manager was in post. A registered manager is a person who has registered with 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.

At this inspection, improvements in monitoring and resolving problems in the running of the service resulted in sufficient progress to meet the previously breached regulation for staffing. However, we concluded that more progress was still needed to ensure the processes for medicines and governance were fully embedded and development of the service was maintained. Previous areas identified as requiring improvement, about peoples care needs and risks, staff training, care planning and activities had suitably improved.

People were protected from harm by staff who were trained to recognise signs of abuse. Where risks to people were identified, staff acted to minimise them. There were enough staff to meet people's needs and staff were recruited safely. People were protected from the risk of infection by robust prevention and control measures. Analysis and reflective practice meant lessons were learned when things went wrong.

Medicines were given to people as prescribed and disposed of safely by properly trained staff. However, the storage, recording and stock control was not always robust or in line with guidance.

People's needs were assessed before they moved into the service. These needs were met by staff who had the skills and knowledge to deliver effective support. People were supported to eat and drink enough to have a balanced diet, including those with associated health needs. People were supported to have healthier lives by having timely access to healthcare services. People lived in an environment which was suitable for people living with dementia. People were supported to have maximum choice and control of their lives, staff supported them in the least restrictive way and the policies and systems in the service reflected this practice.

People received a service which was caring, they were treated with dignity and respect. Staff were compassionate and caring, this was commented upon positively by people and their visitors. Staff treated people's private information confidentially. People, where possible, made decisions about how their care was provided and were involved in reviews of their care together with people important to them.

Care was personalised to people's individual needs an

The inspection was carried out on15 August 2017 and was unannounced. This meant the provider and staff did not know we would be visiting. The service was previously inspected in March 2017 and was rated good.

The service did not have a registered manager. 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. The previous registered manager had retired; the provider had appointed a new manager they commenced on 19 June 2017. They told us they intended to register with CQC but had not yet commenced the process. However, since our inspection we have been informed by the provider that the new manager had left. The service will be overseen by the provider and the operations manager until a new manager is in post.

Emyvale House is situated in West Melton close to the village of Wath-Upon-Dearne which is approximately six miles from the town of Rotherham. The home provides care for up to16 older people. Bedroom facilities are provided on the ground, first and second floor level of the building. Access to the first and second floor is by a lift. There are communal areas including a lounge, small conservatory and a separate dining area. There is a small car park at the front of the building and a small enclosed garden to the rear.

Before this inspection we received information of concern. Concerns were in relation to staffing levels, and the management of the service. We therefore brought this inspection forward.

Staff we spoke with were aware of safeguarding policies and knew the procedure to follow if they suspected abuse. Staff were also familiar with the whistle blowing procedures.

Care records and risk assessments lacked sufficient detail to ensure staff were aware of people’s needs, therefore put people at risk of unsafe care and support.

Medicine management did not always protect people against the risks associated with the unsafe use of medicines. Arrangements were in place for the recording, safe keeping and safe administration, however, these were not always followed.

Adequate staff were not always on duty to meet people’s needs. We identified staff were performing numerous roles and covering additional shifts to try to ensure people’s needs were met.

Staff told us they received training that ensured they had the competencies and skills to meet the needs of people who used the service. However, the training record did not support this, the records showed training was not up to date and some staff had not attended all necessary training. However, the new manager confirmed that many courses had been booked for staff to update their knowledge.

We found the service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. At the time of our inspection there were no approved DoLS and none were waiting assessment.

People received a well-balanced diet that met their needs. The meal we observed was a relaxed enjoyable experience for people.

We found staff approached people in a kindly manner. We observed staff were caring and considerate. Staff respected people and treated them with dignity. People we spoke with confirmed this and told us they were involved in decisions about their care and support.

We observed no activities taking place during our inspection. People and their relatives told us that activities were very infrequent as the activities coordinator was on maternity leave. A new coordinator had been appointed but was also covering care duties so there were insufficient activities taking place to meet people’s needs.

Emyvale House is a care home for older people, providing accommodation and personal care for up to 16 people over three floors. It is situated in West Melton which is approximately six miles from the town of Rotherham. At the time of our inspection there were no vacancies at the home.

At the last inspection, the service was rated overall ‘Good’ with some areas requiring improvement in the ‘Safe’ domain. At this inspection we found the service remained ‘Good’ and improvements had been made.

The home had a registered manager. 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.

People told us they felt safe living at the home. Assessments identified potential risks to people, and management plans were in place to reduce these risks. Staff were knowledgeable about how to recognise signs of potential abuse and aware of the reporting procedures.

Recruitment processes were thorough and helped the employer make safer recruitment decisions when employing new staff. At the time of the inspection there was sufficient staff to meet people’s needs and a new rota system had been introduced to help ensure enough staff were always on duty.

Systems were in place to make sure people received their medications safely, which included key staff receiving medication training and regular audits of the system.

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

Staff had completed an induction and essential training at the beginning of their employment. This was followed by additional training and periodic refresher sessions. They also received regular support and supervision to help them meet people’s needs.

People were supported to eat and drink sufficient to maintain a balanced diet, and snacks were available in-between set mealtimes. The people we spoke with said they were happy with the meals provided.

People were treated with respect, kindness and understanding. Staff demonstrated a good knowledge of how to respect people’s preferences and ensure their privacy and dignity was maintained. We saw staff took account of people’s individual needs and preferences while supporting them.

People had been encouraged to be involved in planning their or their family members’ care. Care plans checked reflected people’s needs and had been reviewed and updated to reflect people’s changing needs.

People had access to social activities, as well as occasional outings into the community. However, the recording of their participation did not always provide sufficient detail to evidence what activities people enjoyed.

There was a system in place to tell people how to raise concerns and how these would be managed. People told us they had no complaints, but would feel comfortable raising any concerns with the registered manager.

People we spoke with told us the registered manager was visible around the home, approachable, always ready to listen to them and acted promptly to address any concerns.

There were systems in place to assess if the home was operating correctly and people were satisfied with the service provided. This included meetings and regular audits. ln the main, action plans had been put in place to address areas that needed improving.

Further information is in the detailed findings below.

The inspection was unannounced, which meant the provider did not know we were coming. It took place on 10 June 2016. The home was previously inspected in May 2015, this was a focused inspection as we had received concerns. It was not a rated inspection, however, we found two breaches of regualtions.

Emyvale House is a care home for older people. providing accommodation and personal care for up to16 people over three floors. It is situated in West melton which is approximately six miles from the town of Rotherham.

The home had a registered manager. 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 saw there were systems and processes in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding vulnerable people and were able to explain the procedures to follow should an allegation of abuse be made.

People’s needs were assessed and care and support was planned and delivered in line with their individual support plan. The individual plans we looked at included risk assessments which identified any risk associated with people’s care.

Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role. However, we identified these had not always been followed.

People were supported to eat and drink sufficient to maintain a balanced diet and snacks were available in-between. People we spoke with who used the service told us they liked the food and could choose what they wanted and when they wanted to eat.

We found there were enough staff with the right skills, knowledge and experience to meet people’s needs. However, at times due to staff shortages and holidays staffing levels fell below the required hours that the dependency tool determined so peoples needs may not always be met in a timely way.

Staff were provided with appropriate training, support and supervision to help them meet people’s needs.

We found the service to be meeting the requirements of the mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a good understanding of the requirements.

Systems were in place to assess and monitor the quality of the service, including obtaining feedback from people who used the service and their relatives. Records showed that systems for recording and managing complaints, safeguarding concerns and incidents and accidents were managed well and that management took steps to learn from such events and put measures in place which meant lessons were learnt and they were less likely to happen again.

We last carried out an inspection under the Care Quality Commission’s old methodology on 1 August 2014 and on 1 October 2014. In May 2015 we received concerns in relation to people’s safety. The concerns were lack of staff on duty to meet people’s needs, concerns relating to one of the rooms and that 18 people were being accommodated when the service was only registered to provide accommodation for 16 people. As a result we undertook a focused inspection to look into those concerns.

This report only covers our findings in relation to this topic. You can read the report from our last inspection, by selecting the 'all reports' link for Emyvale House on our website at www.cqc.org.uk

We undertook this focused inspection to determine people who used the service were safe. We have not yet carried out a comprehensive inspection to provide a rating for this service under the Care Act 2014

Emyvale House is situated in the village of Wath-Upon-Dearne which is approximately six miles from the town of Rotherham. The home provides accommodation and care for up to16 older people. Bedroom facilities are provided on the ground, first and second floor level of the building. Access to the first and second floor is by a lift. There are communal areas including a lounge, small conservatory and a separate dining area. There is a car park at the front of the building and gardens to the rear.

The home had a registered manager who has managed the service for 12 years. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

At this inspection we found, while most people said they were very happy with the service and praised the staff very highly, some also raised a number of concerns. Our observations and the records we looked at did not always match the positive descriptions some people gave us. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in that people did not receive safe care and treatment and there were not always enough staff on duty to meet people’s needs.

The provider had safeguarding policies and procedures in place to guide practice. Staff we spoke with were aware of procedures to follow including whistleblowing if it was necessary. However we found safeguarding concerns during our inspection and we submitted two safeguarding referrals to the local authority following our visit.

There were not always enough staff to meet people’s needs. People who lived at the home told us the staff were very good, worked hard and tried to ensure they met their needs. However, people also said the staff were always very busy. One person told us, “At night sometimes I wait a long time for assistance, staff tell us they are busy with other people.” Relatives we spoke with praised the staff and told us they were very caring and considerate, but at times were extremely busy and more staff were required.

People’s needs had not always been assessed. We found no care plans were in place for people who received a respite service. Risk assessments relating to health, safety and welfare of people who used the service had not been completed. This put people at risk of inappropriate care that did not meet their needs.

We found that the provider had on an occasion had 17 people staying at Emyvale house when it was only registered for 16. The extra person was accommodated in an attic room that was not fit for use.

Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were protected against the risks associated with the unsafe use and management of medicines.

Is the service effective?

The provider had implemented an effective system to regularly assess and monitor the management of medicines.

People we spoke with told us they received their medication when it was required. One person told us they administered their own medication. This was kept in a locked cupboard in their room.

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people.

Is the service responsive?

The manager had ensured the new systems for monitoring the management of medication was followed. Staff told us they had received update training in medicine management and had all received a competency assessment. This ensured people’s prescribed medicines were administered safely.

Is the service well-led?

The staff we spoke with said they worked well as a team and had improved systems in place at the service to ensure people’s needs were met.

Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found adequate quality monitoring systems were in place. Which the manager was in the process of improving to ensure the risks to people were identified and reduced, to be able to continually improve.

People were cared for in a clean, hygienic environment.

People were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements for the recording, safe keeping and safe administration of medicines were not place. We have asked the provider to tell us how they will make improvements and meet the requirements of law in relation to management of medicines.

Is the service effective?

People’s health and care needs were reviewed, and people were involved in the reviews.

Audits and reviews had taken place, however these could be more detailed. The manager had identified this and was in the process of implementing new audit tools.

Is the service caring?

We observed care workers interacted positively with people who used the service. Conversations were inclusive and we observed staff and people who used the service laughing and joking together. People we spoke with told us the staff were lovely. One person said, “All staff are very kind and caring, they respect my wishes and feelings and there is nothing they could do better.”

People were supported to be able to eat and drink sufficient amounts and the diet provided was balanced and healthy.

People told us they enjoyed the food and one person said, “The food is always marvellous.” Another person told us. “You put on weight when you come here the food is so good.”

Is the service responsive?

The manager had identified shortfalls during an infection control audit and had put measures in place to ensure improvements.

The manager responded appropriately to the shortfalls we identified in management of medicines and addressed issues during our visit to ensure improvements.

Is the service well-led?

Staff told us they worked very well as a team. They told us they had regular meeting ensuring communication was good. Staff said, “We work well as a team, which ensures people’s needs are met.”

People we spoke with told us the manager was excellent, she was always available and approachable. People told us the manger always took time to talk and listen and any issues were dealt with immediately.

Relatives we spoke with said the home was well run and they were always kept informed of any changes.

We spoke with five people who used the service. They told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. People said, “This is the best place to live, we are all looked after very well. We are like a big family and you can quote me saying that.” Another person said, "Staff are very kind, staff helped me to get bathed she (the staff) was very gentle and very respectful."

People experienced care, treatment and support that met their needs and protected their rights. People had detailed care and treatment plans relating to all aspects of their care needs. One person said, "Staff are marvellous, caring and kind."

People were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection. People said the home is always nice and clean the staff are very good.

The people who lived in the home were kept safe because the provider had taken steps to maintain the building and we saw that regular health and safety checks had been carried out.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff started work. This included being registered with the relevant professional bodies.

People were protected from the risks of unsafe or inappropriate care and treatment because their records had been reviewed and updated regularly.

We spoke with four people who used the service. They told us what it was like to live at Emyvale House and described how they were treated by staff and their involvement in making choices about their care. We also used a number of different methods to help us understand the experiences of people who used the service. This included observing care, looking at records and talking with staff.

We spoke with one visitor who told us they visited three times a week and always found staff attentive and caring. The visitor said their friend always seemed happy and spoke highly about the care provided at the home.

People we spoke with told us that staff were kind and always treated them with respect.

One person said "I like living here, the staff help me to remain independent, I like to go out on trips and the food is very good." Another person told us they liked to join in the activities and they said they were looking forward to the Christmas party.

We found medication was administered safely to people. People were given appropriate support where required, to ensure they had taken their medication. One person told us they liked to maintain their independence by administering their own medicines.

Staff received appropriate support and training to ensure they were able to meet the needs of people living at the home. We found there were sufficient staff to meet the needs of people who used the service.

Complaints were investigated and responded to in a timely manner.

People told us they liked living at Emyvale House and they enjoyed all of the activities provided at the home. People we spoke with told us they had their rights and choices respected, and staff were kind. One person told us they were having the best Christmas for a long time as they were able to go out to a garden centre and see all of the lovely decorated trees.