Joybrook

About the service

Joybrook is a residential care home providing personal care to 12 people at the time of the inspection. The service can support up to 15 older people; some of whom may also have a diagnosis of dementia, or be living with a learning disability or autism.

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

Right Support: Governance systems required improvements to ensure there was consistent oversight of the service. Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

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.

Right Care: Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right Culture: Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 March 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 31 January 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

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 remained requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Joybrook is a residential care home providing personal care for up to 15 people in one adapted building. The service provides support to older people. At the time of our inspection there were 13 people using the service.

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

We required assurances that systems were sustained and available when the registered manager was not present. Risk assessments, safe infection control processes and medicines were not always managed safely. We raised some concerns at the inspection, which the registered manager responded to in a timely manner. However, these issues were not remedied prior to our inspection.

We have made a recommendation in relation to the dementia friendly environment of the home.

Risk assessments were not available to support staff to mitigate risks to people. The provider was aware, and took action to support people that presented behaviours that could challenge others.

Incident records were completed, and safeguarding referrals made where appropriate.

We identified significant staffing shortfalls across the home, meaning staff could not spend time with people outside of task orientated duties. The provider took prompt action to ensure activities staff were reinstated and utilised at the home. Staff training required updating and the provider took action to ensure staff were booked on for refresher sessions. People’s views were sought and the registered manager took steps to improve their response to people’s concerns.

Safeguarding matters were dealt with appropriately and staff had a good understanding of how to report any concerns. People were supported to eat and drink, and received a varied menu that they were able to choose. People and relatives were positive about staff and management, telling us they were caring and supported them well. People were treated with dignity and respect. Healthcare professionals were consulted when people had other care needs that needed to be met.

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.

People, relatives and commissioning bodies were positive about their engagement with the home and how it met their needs.

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

Rating at last inspection and update

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

Why we inspected

We inspected this service after we received intelligence that there had been a recent outbreak of COVID-19.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

During our first day of inspection we identified concerns, and therefore decided to carry out a comprehensive inspection across all domains.

Where we identified issues the provider took prompt and appropriate action to mitigate any risks.

You can see what action 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 Joybrook on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

At the last inspection on 18 May 2016 the service was given an overall rating of Good, with a breach and requires improvement in Effective. The breach was in relation to staff not receiving regular supervisions or annual appraisals. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘Effective’ to at least good.”

At this inspection on 15 and 23 May 2018 we identified the provider had made improvements to the frequency and support provided in staff members supervisions and annual appraisals. Scheduled supervisions took place when planned and staff were encouraged to participate in the agenda, ensuring areas of interest were discussed during the supervision.

Supervisions were recorded and staff were encouraged to request additional supervision meetings as and when they felt necessary. Although there had been improvements in the frequency of supervisions, we also identified the process was not as person centred as it could be. We raised our concerns with the registered manager on the first day of the inspection. One second day of the inspection, the registered manager provided us with an update of supervision records, which were person-centred and tailored to individual staff members.

Joybrook 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.

Joybrook accommodates up to 15 people in one adapted building. Joybook is a large residential house situated in a quiet road in the London borough of Lambeth. At the time of the inspection there were 14 people using the service.

The service had a registered manager in place. 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 received training in safeguarding and whistleblowing, which enabled them to identify, report and escalate suspected abuse. Risk management plans identified known risks and gave staff clear guidance on how to mitigate risks in a safe manner. Changes to risk management plans were shared with staff members swiftly.

People’s medicines were managed safely. Medicine records were completed correctly and staff confirmed they received training in medicines management. People continued to be protected against the risk of cross contamination as the provider had robust infection control measures in place.

Staff continued to receive on-going training in all aspects of their roles and responsibilities. People and their relatives felt staff were well trained and could effectively meet their needs. Staff were confident any additional training they wished to undertake would be provided.

People’s consent to care and treatment was sought prior to care being delivered. The registered manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were encouraged and supported to eat sufficient amounts of food and drink to meet their dietary requirements and preferences. People with specific dietary requirements were catered for in corroboration with guidance from healthcare professionals. People described the food as, ‘very nice’, and ‘filling’.

People received care and support from staff that treated them with dignity, respect and supported their diversity. People were encouraged to acknowledge their culture and faith as they wished. People’s privacy continued to be maintained.

Care plans were person centred and gave staff clear guidance on how to support people in a way they preferred. Care plans were based on service needs assessments, were developed with people, their relatives and healthcare professionals and were reviewed regularly to reflect people’s changing needs.

Complaints were monitored and responded to swiftly. People confirmed they felt comfortable raising matters of concern and felt confident these would be acted on. Incidents and accidents were regularly reviewed to ensure lessons were learned.

People’s views were encouraged and sought regularly to improve the service. Where views were shared and issues identified, these were acted on in a timely manner. The provider carried out regular audits to improve the service delivery. The registered manager continued to encourage partnership working with other healthcare professionals. Guidance given was then implemented into the delivery of care.

This unannounced inspection took place on 18 May 2016. We last inspected Joybrook on 5 June 2014. The service did not meet all the requirements we inspected that time. The provider was non-compliant with the regulation of notification of other incidents as required by CQC.

The service has 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.

At this inspection we found that the provider had breached Regulation 18 (2) (a) of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. The breach of the regulation relates to staffing. The registered manager had not always supported staff in their roles. Although staff told us they were supported by management, they had not received one to one supervisions or annual appraisal to reflect on their practice. You can see what action we have told the provider to take at the back of the full version of this report.

People were safe at the service. The service had assessed and identified risks to people’s health and safety and support plans had sufficient guidance for staff on how to keep people safe. Staff knew the types of abuse and how to recognise and report any concerns they had to protect people from harm. People received the support they required to ensure their took their medicines safely in line with their prescriptions. Medicines were securely and safely stored at the service.

There were sufficient staff on duty to meet people's individual needs and to support them with their interests. The provider ensured suitable staff were recruited through a robust recruitment procedure.

Staff knew and understood how to communicate with people about their choices and preferences. People told us they were happy to be living at Joybrook. Staff had the relevant skills and training which enabled them to plan and deliver people’s support safely and competently.

Staff spent time and were not hurried when they supported people. Staff knew people well and had developed positive relationships with them. The service supported people to maintain relationships with their friends and family. People were treated with dignity and their privacy was respected. People were asked about their views of the service and the care and support they received and their feedback was acted on. The staff team worked effectively to ensure people had a positive experience of the service.

Staff upheld people's rights and supported them in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff ensured people who lacked mental capacity were not unlawfully deprived of their liberty.

Staff assessed people’s needs and plans were in place to ensure they received the support they needed. Staff regularly reviewed people's health and the support they required to reflect their current level of needs. Care records were up to date and accurate, so that staff could ensure people received appropriate support. Staff supported and encouraged people to be independent. The registered manager sought people's views and opinions about the service and acted on their feedback.

People enjoyed the nutritious freshly home cooked food provided at the service. People could choose what they wanted to eat. People's cultural needs and personal preferences were met in relation to their diet. Staff engaged people in activities of their choice which reduced the risk of isolation and boredom.

Staff monitored people’s health needs and ensured they accessed the healthcare services they needed. The service involved healthcare professionals in a timely manner. Staff knew what to do in case of emergencies to keep people safe.

People understood how to make a complaint and felt confident the registered manager would act on their concern. There were processes in place to monitor quality and understand the experiences of people who used the service. However, the audit systems were not robust enough to identify any areas requiring improvement. The registered manager carried out checks on the quality of the service and made any necessary improvements.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. If the service identified that someone could have been at risk, for example of having a fall, then they put strategies in place to minimise those risks. Staff were aware of these strategies and acted accordingly.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager told us that no one at the service currently had applications submitted under this system. However, it was possible that the provider may need to submit an application in the future.

We found that, although staff had received training in both mental capacity and safeguarding of vulnerable adults, no specific training had been received in relation to the DoLS and the provider did not currently hold a policy describing the operation of the DoLS. The manager was able to describe under what circumstances it might be appropriate to make a DoLs application and what the process was for doing this.

Is the service effective?

We found that people's needs had been assessed and suitable care plans were in place. These were regularly reviewed. Staff described strategies for obtaining verbal consent prior to providing any personal care. The provider acted in accordance with legal requirements where people did not have the capacity to consent.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Is the service caring?

We observed that people were generally relaxed and confident in their interactions with each other and with members of staff. One person told us "I like the people who work here." Another person said "It is pleasant. I do like it here." Someone else using the service told us "I like it. The staff are very kind. This is the best place."

We also spoke with relatives of people who were using the service. One relative told us "Staff are polite and keep me informed." Another person told us they were "pleased so far" with the service provided.

Is the service responsive?

We examined how the service responded to complaints as well as what actions they took. We saw that the service responded promptly to complaints and followed the provider's procedures for addressing complaints. Actions were taken to resolve any problems and these were well documented. More general concerns were raised by people at monthly resident's meetings. These were monitored and responded to.

We looked at responses to any adverse incidents involving people who used the service.The service could show us evidence of how they responded to incidents. We saw that steps were taken to minimise the possibility of any incident recurring.

Is the service well led?

The provider had effective systems to regularly assess and monitor the quality of service that people received. For example, people using the service were invited to attend monthly resident's meetings. Those who did not wish to attend the meetings were invited to make comments to staff members in advance of the meeting. Potential improvements to the service were considered at the meetings. Members of staff were also invited to attend meetings where they could raise any concerns and the quality of care being provided was discussed.

The provider had a system in place to record any adverse incidents which affected the people using the service. There was evidence that learning from incidents took place and appropriate changes were implemented. However, the provider is required to notify the Care Quality Commission about some types of incidents. We found that the provider was not always making these notifications. We have asked the provider to draw up an action plan for how they will identify when these notifications need to be made in the future. We will go back to the service to check that these actions are implemented.

We found that people were respected and their dignity maintained by staff at Joybrook. We found that staff supported people using the service with their care needs.

The provider had a safeguarding policy and procedures for staff and people using the service. Staff were aware of the signs of abuse and the procedure to follow in response to an allegation of abuse.

The building was appropriate for the needs of people using the service. There was a programme for building repair and redecoration and some of this work was being carried out at the time of the inspection.

The staff we spoke with told us that they enjoyed working at Joybrook.

We spoke with a monitoring officer from the local authority and they told us that they had no concerning information about Joybrook. They supplied us with their most recent monitoring visit report. This gave us evidence that the medication was being handled and administered correctly and that the local authority was satisfied with the care being provided.

We spoke with the manager of Joybrook and they told us about the actions they had taken to improve the handling of medicines. There had been regular and recorded audits of the medication administration records and action had been taken when any recording errors were identified. The manager confirmed that there had been no incidents of medication being administered incorrectly.

The manager told us there had been no incidents to notify us about but that she was aware of what we should be notified about.

Our records show that we have not received any concerning information about this service.