Jah-Jireh Charity Homes Leyland

Updated 19 May 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Jah-Jireh Charity Homes Leyland (Jah-Jireh) is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Jah-Jireh Charity Homes Leyland (Jah-Jireh) is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. However, the service had employed a manager to oversee the service until a permanent manager could be recruited.

Notice of inspection

This inspection was unannounced on the first day of inspection and announced on the second.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We undertook a physical inspection of the service. We spoke with four people living at the service, and six members of staff including the manager, the business manager, the head housekeeper and three care staff. We also spoke with a visiting healthcare professional. We looked at records in relation to people who used the service including four care plans and multiple medication records. We looked at records relating to recruitment, staff rotas and systems for monitoring the quality of the service provided.

We observed the delivery of care and support throughout the day. We spoke to three relatives to help us understand their experience of the care and support their loved one received.

After the inspection we continued to seek clarification from the provider to validate evidence found. We looked at environmental, staff training and quality assurance records. We also spoke with three relatives on the telephone.

Updated 19 May 2022

About the service

Jah-Jireh Charity Homes Leyland (Jah-Jireh) is a residential care home registered to provide accommodation and personal care for up to 36 people. At the time of the inspection 28 people were living in the service.

The home is established and run for the benefit of dedicated, baptised Jehovah's Witnesses. The home is located in a Victorian dwelling and accommodation is over two floors. Facilities include two lounges, a dining area and an enclosed rear garden.

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

People living at the home benefitted from a service that had made significant improvements since the last inspection. Further time was required to evidence that improved practices had become embedded into the running of the home.

The manager and provider encouraged an open culture of learning from incidents, accidents and other relevant events.

Although adequate systems were in place to ensure risks to people were managed and mitigated, we have made a recommendation about reviewing and updating peoples’ risk assessments, to ensure clear guidance for staff to follow.

Although people received care that was person centred and based on their individual needs and preferences, we have made a recommendation that people’s care records reflect people’s decisions and choices, including information to enable them to receive the correct support at the end of their life.

Parts of the service had been refurbished and the environment was sufficiently clean and well maintained.

Staffing levels were sufficient to ensure people received the care and support they needed in a timely way.

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.

The service involved people, their relatives and staff in a meaningful way. People's views were listened to and acted upon, meaning they had a direct say in the running of their home.

Clear and effective governance processes had been overhauled to help monitor and improve the quality and safety of the service. Processes were underpinned by a commitment to deliver high quality, safe care and support tailored to the person.

The manager acted in accordance with their legal and regulatory requirements and shared information in an open, honest and timely manner.

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 inadequate (report published 27 July 2021) and there were breaches of regulations in safe care and treatment, safeguarding, consent, staffing and good governance. 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 27 July 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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 inspection was carried out to follow up on action we told the provider to take at the last inspection. We checked whether the Warning Notices we previously served in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met, and found that they had.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Jah-Jireh Charity Homes Leyland (Jah-Jireh) on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.