Jah-Jireh Charity Homes Wigan

Jah-Jireh Charity Homes Wigan provides accommodation, personal and nursing care for people who are baptised members of the Jehovah's Witness faith. The accommodation is divided over two floors and is located in a residential area of Wigan. The home can accommodate up to 47 people. At the time of inspection 45 people were living at the home.

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

The provider had improved auditing systems since our last inspection where we identified issues with governance and quality assurance systems. At this inspection we found further improvement with audits was still needed. People were supported in a person-centred way and people and relatives felt the providers values represented their faith and religious beliefs. Relatives felt they were kept informed by the provider when things went wrong. People felt in control of their care and support and praised staffs support of them.

People and relatives felt care and support was provided safely. The provider and staff had a good understanding of safeguarding and how to escalate any concerns. Staff were recruited safely with appropriate checks in place. Safety checks had been completed within appropriate timescales. However, some actions identified as part of checks had not been completed in a timely manner. We discussed this with the provider who shared a plan with realistic timeframes to address this issue. Accident and incidents were recorded and the provider promoted good IPC practice throughout the home. Medicines were managed safely and staff received training, we found some gaps in record keeping related to medicines but felt this was related to auditing systems. We have made a recommendation record keeping relating to medication is improved.

Staff received a robust induction programme and compliance with training was good. Some staff felt training would be better delivered face to face than online which was mainly utilised. We fed this back to the provider who provided a training schedule which included face to face training. We found some inconsistencies within people’s care plans; however, the system the provider used was robust and the issues noted were minor. We have made a recommendation care plans and related records are reviewed to improve accurate record keeping.

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.

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 11 August 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 some improvements had been made. However, we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 comprehensive inspection to calculate the overall rating. The overall rating for the service has not changed based on the findings of this inspection. 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 Jah-Jireh Charity Homes Wigan 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.

Jah-Jireh Charity Homes Wigan provides accommodation, personal and nursing care for people who are baptised members of the Jehovah’s Witness faith. The accommodation is divided over two floors and is located in a residential area of Wigan. The home can accommodate up to 47 people. At the time of inspection 42 people were living at the home.

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

We identified issues with the management of deprivation of liberty applications and the provider’s audit and quality monitoring process. We have also made a recommendation relating to medicines management.

People told us they felt safe living at Jah-Jireh Charity Homes Wigan. Staff had received training in safeguarding and knew how to identify and report any concerns. Enough staff were deployed to meet people’s needs and keep them safe. Accidents and incidents had been logged, although lessons learned and actions taken to prevent a reoccurrence were not clearly recorded. Equipment had been checked and maintained in line with guidance. However, the home could not provide an up to date fire risk assessment. The completion of this was arranged following the inspection. Overall medicines were being managed safely. We have made a recommendation about the medicines audit process, to ensure any errors are picked up and addressed timely.

Staff received sufficient training and supervision to carry out their roles effectively. Assessments were completed prior to people’s admission, to ensure the home was suitable and could meet their needs. 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. Applications to allow the home to legally deprive a person of their liberty had been submitted. However, systems to ensure reapplications were submitted timely required improvement. People’s healthcare needs were being met. Referrals had been made timely to professionals when any issues had been identified. People were happy with the food provided, with choices available at each mealtime.

The service had a clear management system in place with the registered manager being supported by a business manager. People and staff spoke positively about the management of the home, telling us management were a visible presence and they felt listened to and supported. However, the home did not have a clear and robust audit process in place, to ensure any issues were addressed timely and consistently.

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 January 2020) and there was one breach of regulation. The service remains requires improvement. The service has been rated requires improvement for the last two inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 and 5 December 2019 when a breach of legal requirements was 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.

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, effective and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 Jah-Jireh Charity Homes Wigan 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Jah-Jireh Charity Homes Wigan provides accommodation, personal and nursing care for people who are baptised members of the Jehovah’s Witness faith. The accommodation is divided over two floors and is located in a residential area of Wigan. The home can accommodate up to 47 people. At the time of inspection 45 people were living at the home.

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

Medicines had not been managed safely on a consistent basis. We identified issues with training and competency checks, the management of topical medicines and with the administration of some people’s medicines.

Staff spoke positively about the training and support provided, however refresher training and supervision sessions had not always been provided in line with company policy.

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 management of the DoLS process required strengthening to ensure applications had been submitted timely.

Some quality monitoring systems and processes had been used, however there was not a clear audit schedule in place, to ensure regular checks had been completed and issues identified consistently.

People and their relatives spoke positively about the care provided at Jah-Jireh Charity Homes Wigan. Staff were described as kind, caring and thoughtful. Staff ensured they knew people well and provided support in line with people’s needs and wishes.

People told us they felt safe living at the home and enough staff were deployed to support them safely and effectively. Staff were knowledgeable about how to identify and report any safeguarding concerns, which had been referred to the local authority as per guidance.

We found the home to be clean, odour free with effective cleaning and infection control processes in place. Safety checks of the environment and equipment had been completed in line with guidance.

People and relatives were complimentary about the food and drink available, telling us they received a range of daily options choice and enough was provided. People requiring a modified diet received these in line with guidance.

People’s healthcare needs were met with referrals made timely to professionals when any issues had been noted. Equipment was in place to support people to stay well, such as pressure relieving mattresses and cushions, for people at risk of skin breakdown.

Care files contained personalised information about people, their lives, preferences and how they wished to be supported and cared for. Peoples’ social, recreational and spiritual needs were met through the home’s activities programme.

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 (report published June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A comprehensive inspection was last carried out on 01 and 02 March 2016, when we rated the service as ‘requires improvement’ overall and found two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these were in relation to following safe procedures in the recruitment of staff and assessing risk. At this inspection we found the provider was now meeting the requirements of these regulations.

Jah-Jireh provides accommodation, personal care and nursing care for up to 45 people who are baptised members of the Jehovah's Witness faith. The care home is a purpose built two storey building with bedrooms on both floors. It is situated in a residential area of Wigan close to shops and public transport links. At the time of our inspection there were 39 people living at the home.

At the time of inspection 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.

Each person we spoke with told us they felt safe. Relatives expressed no concerns about the safety of their family members and were positive about the level of care provided. We saw the home had appropriate safeguarding policies and procedures in place, which gave instructions on how to report any safeguarding concerns to the local authority. Staff had received training in safeguarding vulnerable adults and demonstrated a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

We found the home was clean throughout and had appropriate infection control processes in place. Hand hygiene guidance and equipment was located in all the bathrooms and daily, weekly and monthly cleaning schedules were in place which specified the different tasks that needed to be completed and the equipment needed for each task. We saw immediately after the lunch time meal, staff vacuumed the dining room carpet to ensure it was free from crumbs and food items.

Staffing levels throughout the day and night were appropriate to meet people’s needs. Staff, people who used the service and relatives we spoke with confirmed this. A dependency tool was used and updated each month to ensure levels remained safe and effective. The home had considered which times of the day were the busiest and organised rotas based on this information, for example two staff were rota’d to work 8.00 -13.00 purely to assist with bathing during morning routines.

We saw medicines were stored, handled and administered safely and effectively. Staff responsible for administering medicines were trained and had their competency assessed. Audits were completed regularly in a range of areas including administration and recording and we saw evidence these had identified issues and lead to improvements in practice.

Staff demonstrated a sound knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We saw the service was working within the principles of the MCA, and conditions on authorisations to deprive a person of their liberty were being met. Applications had been submitted were required and systems in place ensured re-applications had been made prior to authorisations expiring.

The home was in the process of completing a training matrix after the registered manager identified this was not in place when they commenced working at the home. As this was a work in progress, we noted a number of gaps, however staff confirmed they had completed all required training sessions and we saw a plan was in place to ensure refresher session had been completed with all staff during the next two months. Staff told us received regular supervision and annual appraisals, which along with the completion of regular team meetings, ensured they were supported in their roles.

We observed meal times to be a positive experience, with people being supported to eat where they chose. Staff engaged in conversation with people, explained the choices available and provided support where needed. People we spoke with were complimentary about both the quality and choice of meals available, with individual requests being facilitated if people didn’t like what was on offer.

Throughout the inspection we saw interactions between the staff people who used the service were both positive and appropriate. Staff were observed to be friendly, caring and treated people with kindness, dignity and respect. People using the service commented on everyone being like ‘one big family’ and feeling very ‘happy’ about living at the home. The registered manager told us, “We are a family, everyone here is a practising Jehovah’s Witness and we all worship together.” We saw throughout the inspection that people’s spiritual needs and wishes were at the forefront of the service’s ethos and supported accordingly.

We looked at six care files which contained detailed information about the people who used the service and how they wished to be cared for. Each file contained detailed care plans and risk assessments, which helped ensure people’s needs were being met and their safety maintained. People had been involved in discussing and planning their care. Reviews were completed on a monthly basis; and whilst people told us they were involved in discussions, care files did not capture this had occurred.

The home had a comprehensive activity schedule in place, which was heavily focussed on people’s spiritual needs. Everyone we spoke with was positive about the type and frequency of activities available and felt what was offered reflected their needs and wishes.

The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a daily, weekly and monthly basis and covered a wide range of areas including medication, care files, infection control, health needs and the overall provision of care. We saw evidence of action plans being implemented to address any issues found.

We last inspected Jah Jireh Wigan on 25 and 26 March 2015 when we rated the home as requires improvement overall and found four breaches of the regulations. The breaches of the regulations were in relation to staffing levels, medicines management, safety of the premises and monitoring the safety and quality of the service. We issued and warning notice in relation to our concerns around staffing, and the provider sent us an action plan to tell us how they would be compliant with the other regulations breached.

We found action had been taken to make improvements and the provider was meeting the requirements of these regulations. At this inspection we identified two breaches of the regulations, which were in relation to following safe procedures in the recruitment of staff and in relation to assessing risk. You can see what action we have told the service to take at the back of this report.

Jah-Jireh provides accommodation, personal care and nursing care for up to 45 people who are baptised members of the Jehovah’s Witness faith. The care home is a purpose built two storey building with bedrooms on both floors. It is situated in a residential area of Wigan close to shops and public transport links. At the time of our inspection there were 33 people living at the home.

There was a registered manager in post at the time of the inspection. 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 registered manager was due to retire shortly after our visit and an existing member of staff had been successful in applying for the manager’s post.

The day prior to our inspection visit the service had changed the function of some of the communal areas to create a new quiet dining area and a larger lounge-diner. This appeared to have worked well and we received positive comments from people living at the home.

The meal-time experience was positive and we saw people were supported to eat and drink as required in a dignified manner. The home was catering to meet people’s dietary preferences and requirements.

The environment at the home was clean and safe. People told us they felt safe living at the home, but some people commented that they thought more staff were required. Two people we spoke with told us there could be delays in receiving support. We found some people were not supported to get up from bed until around 10:30, which staff told us was due to their support needs. Other than this, during the inspection we saw people received support in a timely manner. Staff told us changes had recently been made to procedures and staff were allocated to provide support to certain individuals. The registered manager told us they were also encouraging staff to take breaks in the communal areas to help ensure there was sufficient cover for these areas.

People told us their spiritual needs were well met by the service. A range of spiritual activities took place including letter writing with the local congregation, and a ‘link-up’ with services at the Kingdom Hall.

Improvements had been made to make the environment more accessible to people living with dementia. This included directional and pictorial signs, and some people had their photos on the door of their bedroom to help them identify it. Further improvements were planned and the service was seeking guidance on developing the service for people living with dementia from an external professional. Staff had received training in dementia care and we received positive feedback from a health professional who told us they had seen a positive change in staff attitude and approach following this training.

Staff told us the provision of activities for people living with dementia had improved. There were ‘rummage boxes’ and staff told us they would hold reminiscence sessions and do activities such as ball games. However, during the inspection we saw limited interaction and stimulation for people living with dementia who did not join in with the spiritual activities held.

Most interactions we observed between staff and people living at the service were positive and friendly. Staff were responsive to people’s needs and we saw staff ensured people were comfortable, for example, by getting people cushions. However, we observed two instances where there was limited communication from staff supporting people with a hoist.

Medicines were being stored and administered safely. Not everyone had clear guidance in place for staff to follow in relation to administration of ‘when required’ medicines. The acting manager told us they had audited who was receiving when required medicines and would ensure guidance was in place by the end of the month.

We found planning of end of life care was basic. End of life care plans had not been regularly reviewed and there was no information or guidance in the care plan for staff in relation to observing for symptoms of signs of pain. There had been no recent training in end of life care provided to staff. The acting manager told us the service worked closely with district nurses and Macmillan nurses in the provision of end of life care.

We received positive feedback from the safeguarding team about improvements made by the service in relation to how they responded to accidents such as falls. We found staff were aware of the correct procedures to follow if someone fell. However, we found one person had sustained a recent fall and we found their risk assessment had not been reviewed following two previous falls. This meant not all measures had been taken to reduce the risk of falling to this individual. The acting manager confirmed actions had been taken to make the referral and they told us a new falls audit had been developed prior to the end of the inspection.

The complaints policy was displayed within the home. People told us they had no fears about making a complaint. However, two people said they would be reluctant to make a complaint as they didn’t want to offend staff who they said were hard working. We saw feedback was sought from people living at the home through surveys and regular meetings. People had been consulted on planned changes and developments to the service.

Audits of medicines and care plans had been introduced and a supervision tracker had been put in place. This would help the manager effectively monitor the safety and quality of the service. There was no analysis carried out of indicators such as falls or hospital admissions although this was carried out at an individual level. There were also no recorded checks of window restrictors or bed-rails. The acting manager told us they would add these checks to the regular room checks carried out.

Care plans were in place and had been regularly reviewed. People’s preferences were assessed on admission and recorded within care plans. Care plans showed evidence of input from families and a range of health and social care professionals. Records showed staff followed the advice given as a result of any healthcare assessments.

One person’s care plan we looked at lacked detail in relation to the requirement of staff to assist them with re-positioning to reduce the risk of pressure sores. Staff told us they did support this person to re-position and the registered manager told us they would put the appropriate documents in place to ensure this was monitored correctly.

We asked the following five questions.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

Most of the people we spoke with who lived in the home and their relatives were pleased with the care provided and felt their views were respected and listened to. One person said: 'It's the best place going.' Another person said: 'I feel safe.' The staff worked in a safe and hygienic way and used appropriate protective clothing.

Some of the staff, people who lived in the home and relatives we spoke with felt there was not enough staff to meet the needs of the people who used the service. A member of the management team was available on call in case of emergencies. One relative said: "Sometimes there has been a shortage through illness." Another person said: 'I don't think there is enough staff.'

The business manager and the staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any incidents of abuse.

Is the service effective?

People told us they were happy with the care that had been delivered. A person who lived in the home said: "They do their best." A relative said: "They look after me too."

Care records confirmed people's preferences, interests and needs had been recorded and care and support had been provided in accordance with people's wishes. One person said: "They never refuse us anything."

We heard information was shared very effectively between staff. Several ways of sharing information included handovers, daily records, and monthly reviews with relatives.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and encouragement when supporting people. One relative said: "They are very, very caring." One person who used the service said: "I think they are wonderful."

Is the service responsive?

People's needs had been assessed before they were admitted to the home. Their needs were carefully described so care workers knew exactly what tasks to undertake to support them. Changes in people's care needs were reported to the nurse team leader and they briefed care staff at handovers and via the updated care plans. One relative said "They are very good, very fair." They also commented the chiropodist, the speech and language therapist, the dietician visited regularly and a doctor visited weekly. They felt their relative was receiving good care from the team.

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. People told us they had received customer satisfaction surveys and that staff listened to their concerns. The manager met informally with families and we saw notes of these meetings indicating feedback was given about improvements made in response to people's suggestions. The manager was also readily available whenever relatives visited.

Staff told us they were clear about their roles and responsibilities and said they felt supported by management. One person said: "They listen. They are kind and caring."

A visitor told us; 'it is wonderful, I feel my relative is safe here.'

The menu provided a degree of flexibility for people and in practice it meant that at any mealtime it was likely that everyone was able to eat something they had chosen.

The home had an adult protection procedure designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

The provider had taken appropriate steps to ensure that there were safe recruitment procedures in place and that people who were not suitable to work with vulnerable adults were not employed within the service.

Staff members completed an induction when they started work at the home; a new staff member confirmed this during our visit. We also looked at staff training and saw that mandatory and other training in areas such as safeguarding, moving and handling, dementia care and palliative care was being provided.

Information about the safety and quality of service provided was gathered on a continuous and on-going basis.

We found that people were given choices about their care and all of the people we asked told us they felt safe at Jah-Jireh. Staff told us that they felt supported and that they received appropriate training. People living at Jah-Jireh told us they thought staff were competent to undertake their roles.

We found that people had detailed assessments completed on most occasions but we found that the information obtained was not always used to plan appropriate care for people.

We looked at complaints during our visit and found that there had been no complaints made since the service was registered under the Health and Social Care Act in 2010. The service had a complaints policy and we saw that comments and compliments about the service were recorded.