Jaden House

Jaden House is a residential care home providing accommodation and personal care to up to 5 people. The service provides accommodation and support to people transitioning into more independent living. At the time of our inspection there were 5 people using the service.

People’s experience of the service and what we found:

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. We considered this guidance as there were people using the service with mental health conditions, a learning disability and who are autistic.

Right Support: People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were required to have their medication administered to them in the office by staff and not in a location of their choosing. This included people who had been assessed as being able to store and administer their medicines independently. People were restricted access to communal areas of the home as there was a process in place where people were not to be in communal areas of the home after 11pm. People did not have their own front door key and were not able to access their home independently.

Right care: Care was not always person centred. We observed some systems in place did not provide people with the opportunity to retain and develop their skills. We saw people’s care plans lacked detail, The registered manager told us “Some staff support people more then other staff”, This meant people sometimes had inconsistent support. Risk assessments were not always in place or did not provide enough detail. People were at risk of harm because staff did not always have the information they needed to support people safely.

Right culture: The ethos, Values, attitudes and behaviour of leaders and care staff did not always ensure people using services lead, confident, inclusive, and empowered lives. We saw records of staff interactions with people that was controlling. People were not always involved in the development of their care plans. People were not always involved in decisions being made about their daily routine or the tasks that they were expected to complete. People were not always listened to when they made suggestions on how they wished to be supported. There was an increased risk that people felt disempowered, isolated and less likely to engage with the staff.

Medicines and recruitment were not always managed safely.

Accidents and incidents were not always managed safely or reported appropriately.

The providers quality and risk monitoring systems were not always effective in identifying and action on shortfalls to ensure that people received safe and high quality care.

Infection control and fire were managed safely.

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 18 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service and the length of time since the previous inspection.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. please see safe and well-led sections of this full report.

You can see what actions we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Jaden house on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, Person centred care, safeguarding people from abuse ,and governance at this inspection.

Please see the action we have told to take at the end of this report. We have served warning notices for the breaches of regulations 13 and 17.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The inspection was unannounced and was carried out on 29 September 2017 by one inspector.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The registered manager was away on holiday at the time of the inspection, which was facilitated by the deputy manager.

Staff were extremely kind, compassionate and caring. They knew people and their family circumstances very well and provided sensitive support to help people at difficult times. Staff were very perceptive, understood people’s moods and body language and responded to this appropriately.

Staff were extremely skilled at creating a culture of support, dignity and respect within the home. This ethos was evident in how people felt about their home and their housemates. People spoke respectfully about one another and supported each other to go about their daily lives with the additional support of staff.

Staff were skilled in communicating with people in a way that met their needs. Information was presented around the home in a colourful and visual way which engaged and involved people who told us they felt valued, listened to and in control.

Staff understood the importance of empowering people to make choices and take control of their lives. There was an excellent focus on person centred support and staff were exceptionally committed and determined in finding ways to help people develop trust, confidence, and self-esteem and achieve excellent outcomes.

Individual and environmental risks relating to people’s health and welfare had been identified and assessed to reduce those risks. Regular safety checks were carried out on the environment and equipment to keep people safe. Plans were in place to manage emergencies and personal evacuation plans were in place for people.

People and staff told us they felt the home was safe. Staff had received safeguarding training and understood how to report abuse. People had been given information about what to do if they had any concerns and who they could speak to.

Effective systems were in place for the safe storage and administration of medicines. Safe procedures and risk assessments were in place for people who wanted to take their own medicines.

Safe recruitment procedures were in place and sufficient staff were deployed, including one to one and two to one staff support. People were supported by staff who had received appropriate induction, training and supervision and had the necessary qualifications, skills and knowledge to meet people’s individual, complex needs.

People were supported to maintain their health and well-being and received advice and treatment from health care professionals when required. People made choices about their own individual food and drink requirements and often cooked their own meals at the time when they wanted to eat.

People’s rights were protected because staff asked then for their consent. Staff understood the principles of the Mental Capacity Act 2005 and ensured decisions were made in their best interests. The registered manager understood the Deprivation of Liberty Safeguards and had submitted requests for authorisation when required. Other notifications were submitted to the commission when required.

People were encouraged to take part in a wide choice of activities and educational opportunities, both at home and in the community, which increased their skills and independence. People were also supported to be involved in their local community.

People were involved in planning their care and regularly reviewing their support plans. Robust record keeping enabled staff and health professionals to monitor the quality and effectiveness of people’s care and support.

There was a positive, supportive and open culture within the home. Staff were positive about working at Jaden House and felt very well supported by the registered manager. Staff felt listened to and involved in the development of the service.

Relatives and staff had opportunities to feed back their views about the home and quality of the service being provided to help drive improvement. Complaints procedures were available and people knew how to raise a complaint, although no complaints had been received.

Robust systems were in place to monitor and assess the quality and safety of the home and these were kept under review by the registered manager and staff.

At this inspection we found the provider implemented monitoring systems and achieved compliance with this essential standard. During the inspection we spoke with the registered manager, a senior support worker and a care worker. We also spoke with two people that used the service. We looked at three people's care records and observed the interaction between staff and people that used the service.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

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

Is the service safe?

Care plans and risk assessments provided detailed strategies in order to support people who may exhibit challenging behaviours. The provider conducted regular audits to ensure people and relatives had the opportunity to express any concerns about their safety in the home or in the community.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. The manager understood when an application should be made and how to submit one and was aware of recent changes to the legislation.

Is the service effective?

Care workers we spoke with had a good understanding of people's needs and told us they felt the care plans and risk assessments in place were effective. We found the provider had an effective system in place to check and reassess the suitability of care workers to work with vulnerable people.

Each person that used the service had a personal emergency evacuation plan in place (PEEP). These plans detailed instructions for care workers and people to follow should a fire take place in the home. We spoke with one person who was able to describe the content of their individual PEEP. This demonstrated the provider had effective emergency fire procedures in place.

Is the service caring?

People's life style choices, preferences, interests, and different needs had been written in their plans and care and support had been provided to make sure these were upheld. Each person we spoke with told us they felt the care workers cared for them properly. One person said: "The staff are really good here, I have never had any problems I needed to complain about. They really care about us and they want us to do well in life".

Is the service responsive?

People's needs had been assessed before they received care.This included involving them in regular care reviews and keeping them or their relatives informed of changes, if appropriate. We saw that people's health needs were monitored and if necessary the support of health care professionals was obtained. This helped to ensure that the delivery of care was responsive to people's needs and based on up to date information and guidance. The records showed that any concerns were followed up and relevant action was taken.

Is the service well led?

There were clear lines of accountability within the service. We saw evidence that regular audits of the quality and safety of the service were carried out. For example, there were audits of the care plans and care workers training records.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at two care plans. We saw they followed a consistent format and contained an assessment of people's needs, the desired outcome and what support was required from staff to achieve such.

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 we spoke with told us they felt safe. One said, "If I had any problems I'd go to my keyworker or the manager".

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were enough skilled and experienced staff to meet people's needs. People we spoke to about staff said "staff are very helpful". Another said "staff are really encouraging, they want me to succeed as much as I do".

The registered person did not regularly assess and monitor the quality of the services provided. They also did not seek the views of service users or persons acting on their behalf to enable the registered person to come to an informed view in relation to the standard of care and treatment provided to service users.

A relative we spoke with said the service was 'brilliant' and there had been full consultation in regard to care and support.

Throughout our visit we observed people were being treated with dignity and spoken to in a respectful way. People were being enabled to do what they wanted for themselves.

We saw that people's privacy and independence were respected, people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs and promoted independence.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding. People's rights were respected.

We saw evidence that staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The Provider had effective systems in place to monitor quality assurance and compliance.