Emily Jackson House

Emily Jackson House is a ‘care home’. People in care homes receive accommodation and 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. Emily Jackson House is registered to provide accommodation and personal care for up to 60 people. At the time of our inspection there were 44 people living in the service. Accommodation is arranged over three floors.

At our last inspection we rated the service as Good. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The registered manager had recently left the service. A new manager had been recruited and would be starting at the service in March 2019. They would be registering with CQC once they were working at Emily Jackson House.

People experienced a service that was safe. Staff had received training about protecting people from abuse, and they knew what action to take if they suspected abuse. Risks to people’s safety had been assessed and people were supported to take positive risks. The premises were maintained and checked to help to keep people safe.

Staff were supported to fulfil their role in meeting people’s needs. The complaints policy was accessible to people using the service.

People were given their medicines safely and when they needed them. Policies and procedures were in place so that people took their medicines when needed. People were supported to remain as healthy as possible and they had been given access to healthcare professionals when needed.

People had access to the food and drink that they enjoyed. People were supported to choose what they wanted to eat and drink. People’s nutrition and hydration needs had been assessed and recorded.

People were treated with kindness and respect. People needs had been assessed and support had been provided to meet these needs.

People were central to the support they received. Care and support was planned with people and their relatives and reviewed to ensure people continued to have the support that they needed. People were encouraged to be as independent as possible.

People took part in activities of their choice. People could choose what they wanted to do each day. There were enough staff to support people to participate in the activities they chose.

People’s records were stored securely within the service.

Processes were in place to monitor the quality of the service and the provider had asked people for feedback about the service.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance hall. The CQC rating was also displayed on their website.

Further information is in the detailed findings below.

The focused inspection was unannounced and was carried out on 23 June 2017 by an inspector. We looked to see how the service ensured staffing levels were sufficient to appropriately meet people’s care needs.

Emily Jackson House is located in Sevenoaks, Kent and is registered to provide nursing care and support for up to 60 older people and those who may have dementia. Accommodation is provided on the ground floor for older people and on the first floor ‘memory lane for people living with dementia. At the time of our inspection, 43 people lived in the home, 19 of whom lived in memory lane.

There was not a registered manager in post. 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.

A registered manager had left and had de-registered with the CQC in March 2017. A divisional operations support manager was managing the home, supported by a regional clinical development nurse, until a home manager who had been newly appointed could start work in August 2017 and apply for their registration. A new deputy manager was due to start work on 27 June 2017. The provider had kept us updated of the interim arrangements to ensure continuity of management in the home. The interim management team was supported by a senior general manager who was also managing another home under the same provider, and a senior regional director.

People’s care needs were met by a sufficient number of staff. There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to residency levels and assessments of people’s individual needs and risks. People told us there were enough staff to meet their needs and make them feel safe in the home.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect. People were able to spend private time in quiet areas when they chose to.

Staff had received all essential training and regular one to one supervision sessions.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them.

People’s mental capacity was assessed when necessary about particular decisions. When necessary, meetings were held to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

Clear information about the service, the facilities, and how to complain was provided to people and visitors. Additional information was provided to help people make informed choices.

People’s individual assessments and care plans were developed in partnership with people, reviewed monthly or sooner when their needs changed.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff took account of people’s individual preferences and pro-actively sought of ways to enhance their quality of life and experience of the service. They promoted people’s independence and encouraged people to do as much as possible for themselves.

People were involved in the planning of original activities that responded to their individual needs. People’s feedback was actively sought at relatives and residents meetings. Complaints were appropriately investigated and responded to in line with the provider’s policies and procedures.

Staff told us they felt valued by the registered manager and they had confidence in her leadership. The registered manager was open and transparent in their approach. They placed emphasis on continuous improvement of the service.

There was a system of monitoring checks and audits to identify any improvements that needed to be made. The management team acted on the results of these checks to improve the quality of the service and care.

During this inspection, we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to residential care homes. We spoke with the manager and saw evidence that appropriate applications for DoLS had been made. All care staff had been trained in DoLS, in the principles of the Mental Capacity Act 2005 (MCA) and in the safeguarding of vulnerable adults. We found that people's mental capacity was assessed according to legal requirements. We found that risk assessments with clear action plans were in place to ensure people remained safe. Emergencies measures were in place and the people who lived at the service had personal emergency evacuation plans. We found that there were enough qualified, skilled and experienced staff to meet people's needs.

Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered. We saw that the delivery of care was in line with people's care plans and assessed needs. A relative of a person who used the service said, "The care is very good. We take part in the reviews of our family member's care plan and the staff do what is planned". Care plans, risk assessments and handover meetings reflected people's current needs. Changes in care plans were effectively communicated to staff. Staff's training was specific to meet people's needs, appropriate and up-to-date. Staff received additional training when requested.

Is the service caring?

We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. We saw that staff showed kindness and patience when they supported people at mealtimes or during activities. Two people who lived at the service told us, 'The staff are very kind', 'They do their best and they are patient'. A member of staff said, 'We treat people who live here as we would like to be treated ourselves'. Comments from satisfaction surveys included, "Staff make me laugh", "I am very happy".

Is the service responsive?

People's needs had been assessed before they moved into the service and their support plans were reviewed regularly to reflect any changes in their needs. People's care plans included written information about their communication needs, personal hygiene, mobility, nutrition, any behavioural support required and their hopes and concerns. We observed that people's requests for help were responded to without delay. However one person told us, and 'The staff work hard but sometimes I have waited half an hour for them to come to me if they are especially busy'. People were able to choose what they preferred to eat. Requests that were made during residents meetings or expressed in satisfaction surveys were followed through and responsive action was taken. Additional training for staff included training on palliative care, challenging behaviour, person centred thinking, catheter care and a handover communication system specific to the service. This ensured that staff were knowledgeable about people's specific needs and were able to respond to them.

Is the service well-led?

The manager operated a system of quality assurance and completed audits to identify how to improve the service. Additionally, a regional director carried out an inspection that included compliance checks and improvement plans. When audits identified the need for an improvement, this was implemented. People and their relatives or representatives and staff were consulted about how the service was run. Annual survey questionnaires were provided and their results were analysed. A member of staff told us, "There is an open door policy as we can always see the nurse or the manager and discuss anything of concern'. A relative told us, 'We have had a few problems with our family member's care and we were able to talk about it with the manager and our concerns were taken seriously. Everything has been sorted out'.

We saw care plans had been completed for each person who lived in the home. We saw care plans reflected the information provided in the needs assessment. Care plans were person centred and reflected the choices and needs of the person.

The service had a Safeguarding Vulnerable Adults policy. We saw that a copy of the policy was held in the manager's office as well as each of the nurse offices and was easily accessible for staff. The staff we spoke with told us that they were aware of this policy and knew where to locate it should they need to do so.

We looked at the formal recruitment records for four members of staff. Each of the files included an application form, two references, employment history and information relating to UK employment eligibility. We also saw that the provider had investigated any gaps in employment histories and these investigations had been recorded within the staff file.

Staff told us that they felt that there was a good skill mix of staff on duty each day and there were enough staff for them to cover all their duties. One relative we spoke with told us 'They do approach things intelligently and make the right call. They communicate well amongst themselves and come to sensible conclusions. They seem to work well as a team and all decisions are taken responsibly'.

People who used the service were not always protected against the risks of unsafe care because accurate records were not always kept in relation to care provided to the person who used the service.

One relative we spoke with told us 'They welcome views. I have always been treated with respect and listened to and they take on board what I have said'. One person who used the service we spoke with told us 'Oh, I just ask if I want something changed'.

Staff told us that they were happy working for the service and said the management was approachable and supportive. One person told us 'I am very supported. I love working here'. Another person told us 'They supervise me very well'.

Our observations showed that some people used different methods of communication, for example, the use of body language or facial expressions. We observed that staff recognised these non verbal communication methods and responded appropriately.

People we spoke with told us that they liked living at the home and felt safe. Comments included "I have no concerns", "I like it here" and "I'm looked after extremely well".

People spoke highly of the staff and described them as "Delightful" and "Nice". People told us that they were happy with the care provided and staff respected their privacy. During our inspection we saw several examples of staff treating people with dignity and respect by knocking on doors and speaking in an appropriate way.