Jemcare

Jemcare is a domiciliary care service providing personal care to people living with learning disabilities and/ or autism, mental health needs, physical disabilities and older people, including those living with dementia. The service was supporting 151 people at the time of our inspection.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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 the CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of ‘Right support, right care, right culture’. People’s care enabled them to have choice, control and independence, including where they chose to make unwise decisions. Care was person-centred and promoted dignity. The provider had an ethos of ensuring people using their service were included and empowered to live their lives as they chose.

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

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

The provider did not always have effective systems in place for monitoring the quality of people’s care and how the service was performing. Processes for submitting statutory notifications was not always consistent. We made a recommendation about the provider’s quality assurance processes.

The provider was focused on delivering good outcomes for people. The service had a positive culture, where people were happy. Staff shared in their commitment to promoting people’s quality of life and looked for opportunities to improve people’s care.

People received safe care, supported by a consistent team of care staff, who knew their care needs. The provider’s most recent survey from people that used the service showed they felt supported to be independent, positive about their care and safe during the COVID-19 pandemic.

Staff had a positive approach to risk management and used their knowledge of people to manage risks effectively. At times, this information was not reflected in people’s care records and behaviour support plans were not always in place. We made a recommendation about positive behaviour support plans. When accidents and incidents occurred, people were supported to be safe and lessons were learnt to improve practice.

Rating at last inspection

The last rating for this service was good (published 28 November 2017).

Why we inspected

We identified potential concern in relation to risk at the service based on our records. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

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.

At the last inspection 15 July 2016 the service was rated overall as Good. However, we found that the way staff were recruited had not always been safe. We asked the provider to take action to make improvements in staff recruitment, and this action has been completed.

The service was managed by the provider who was the registered person for Jemcare. 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 staff were friendly, kind and caring and people valued the service they received. Their privacy and dignity were respected and promoted by the care staff.

People told us that they felt safe when receiving care and support from staff. Staff knew how to recognise and report potential safeguarding issues and they received appropriate training in this area.

There was a robust and detailed recruitment programme in place that helped to ensure people received good standards of care from a skilled staff team. Staffing levels were sufficient to ensure people received standards of care that enhanced their welfare, safety and day to day living.

Staff training, support and development was given a high priority. The care staff were well trained and supported to be able to provide the care people needed. Specialist training was given to staff to meet people’s individual support needs.

Staff received comprehensive induction when they first started work at the service and received on-going supervision and an annual appraisal of their performance. Staff spoke of opportunities for development and were enthusiastic about gaining skills and qualifications in order to support people.

Thorough risk assessments were in place to protect people from risks but also enabled them to take positive risks. Risk assessments and care plans were person centred and up to date.

People were included in planning and agreeing to the care they received. People could ask for changes to their planned care and the service agreed to these where possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

The service had developed good links with healthcare and social care professionals to support people with their health and well-being. Medicines were handled safely and people received support with their medicines as they needed. People received the support they needed to prepare meals and drinks.

The registered provider and senior team set high standards and monitored the quality of the service to check these were maintained. Where issues had been highlighted by people we saw the provider had taken action to address these.

The service was managed by the provider who was the registered person for Jemcare. 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.

People who were supported by Jemcare told us that they felt safe because the staff team understood their responsibilities in keeping people safe

The service was suitably staffed with enough members of the team to allow for suitable care delivery. In the main staff were recruited appropriately but we discovered that some staff had visited service users prior to all checks being completed.

This was a breach of Regulation 19: Fit and proper persons employed. We made a compliance action about this matter.

All staff received an appropriate induction. The service had a disciplinary process that was used if there were any issues of poor practice.

Medicines were managed appropriately by the staff team.

Staff understood how to control infections while working in people's homes.

Staff received suitable levels of training and support to allow for each person to develop in their role.

Staff supported people to have suitable levels of nutrition and hydration.

Health professionals were called on when necessary. Staff were careful to monitor people's health care needs.

People told us that the staff team were kind and caring and that they treated them with dignity and respect.

Assessments and care plans were suitably detailed and up to date. Staff and service users confirmed that these were kept in people's home and updated when needs changed.

People were supported to pursue interests and go out into the community if this was part of their care and support package.

People told us that they were confident that any complaints would be dealt with appropriately. The service had a suitable complaints procedure in place.

We had evidence to show that the team worked well with other professionals when people received care and support from a number of agencies.

Staff and people who used the service said that the provider was accessible and easy to talk to. Staff felt that the leadership was fair and that the service was well organised.

The service had a quality monitoring system in place. We had evidence to show that people were consulted about the care delivery and that changes were made based on quality assurance outcomes.

We learned from the provider and from social workers in Copeland and Allerdale that every person who needed help with medicines had been reviewed. New paperwork had been put in place by social workers. The provider told us that the registered manager had updated all the care plans as a result of this reassessment.The registered manager sent us examples of updated care plans and medicines administration records.

We judged that this meant the regulation had been met but we asked the provider to keep this under review. We will look at medicines management at our next inspection.

"They're great."

"They never let us down."

"We're relaxed with them."

"They're kindness itself."

"They're very polite and very helpful."

We spoke to some relatives during these calls and this is what they told us:

"[My relative] is quite happy with the carers."

"The carers have a laugh with my [relative]."

We also asked people about how they were supported to be given good levels of nutrition. The people we spoke to were satisfied with how staff prepared meals and drinks.

We looked at how staff supported people to take their medication. People told us that they were satisfied with the way this was done. We found some problems with the way this was assessed and recorded and we made a compliance action about this.

We checked on the facilities in the office and found these to be secure and well equipped. We also looked at the way care was recorded and this was generally done very well. Records were kept confidential and were suitably stored in the office. Everyone we spoke to told us that they had a care plan in their home and that staff made records of each visit. They were happy with the content of records.

"They always explain what they need to do...and never force me."

We saw good evidence to show that care was carefully planned in consultation with the person and with other professionals. Care plans were suitably detailed so that staff could give consistent care. People we spoke with said that they were happy with the service.

"My care is wonderful...the service is beyond reproach!"

"It is like having another family of girls who look after me...it stops me being a burden on my own family."

People who were cared for by this service were protected from harm and abuse. The manager had suitable systems in place to report any concerns in an appropriate way.

Staff in the service had good levels of training and support to enable them to care for people. One team member said:

"We get plenty of training. I am one of the trainers for manual handling and I induct new staff. I make sure no one goes out on their own until they are competent."

The manager and the provider had worked on their quality monitoring systems since we last visited and they had good systems in place. They monitored the way staff worked and contacted service users regularly to give people the opportunity to comment on the quality of care.

One person said:

"I have been visited twice by management who checked I was happy with the service."