Juniper House Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. Staff were effectively deployed to meet people’s needs and staffing levels were kept under constant review. Systems were in place to people from abuse and avoidable harm. Management and staff learnt from safeguarding concerns, accidents, incidents and complaints. Learning was shared across the provider's other services.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe and knew how to raise concerns. They were confident action would be taken in response to anything they raised.

Staff understood their responsibilities to report safety events to senior staff. The management team regularly reviewed incidents and shared any learning from these with staff. Incidents that may affect the wider company were shared by the provider. Staff told us how lessons were learned when errors had occurred, and we saw evidence of this in staff meeting minutes.

Learning was part of the culture of the service. Records showed staff recorded and reported accidents and incidents. The provider had systems in place for these to be reviewed and analysed by the management team. Feedback from people and relatives, audits, accidents and incidents and external stakeholder visits were shared with the team as part of lessons learnt and where appropriate shared with the wider company.

People were involved in their initial assessment prior to moving into the service. Information was obtained about their individual needs and preferences.

The registered manager and staff worked collaboratively with health care professionals and the local authority to ensure people’s health and care needs were met.

Professional we contacted told us staff communicated with them effectively and they had no concerns about the service.

Processes were in place to assess people before moving into or returning to the service. More detailed assessments were carried out once people had moved in, and these were kept under review. Where people moved between services important information was shared to ensure continuity of care. Regular meetings were held to discuss changes in people’s needs. The service worked closely with health care professionals who visited weekly to see people and refer them onto other agencies when required.

People felt safe living at Juniper House. One person told us, “I can relax and know that if anything goes wrong there’s someone I can call on. I feel safe”. Another person told us, “Staff are great they keep everyone safe; any problems staff are there. This place is our saviour”.

Staff received safeguarding training and knew how they could access to the providers whistleblowing policy. One staff member said, “Training is good, I have had safeguarding training and know what to do if I see something that is bad like abuse. I would feel ok being a whistleblower if I had to but think the manager would listen anyway”.

People were supported by staff who were kind and caring. We saw that people looked relaxed and comfortable in the company of staff.

Processes were in place to record and report safeguarding concerns to the local authority and the Care Quality Commission (CQC). The registered manager and deputy manager recorded incidents using an electronic system which the provider had oversight. A log was kept of referrals made so the provider could track their progress. The service was working within the principles of the Mental Capacity Act. Legal authorisations were in place to deprive people of their liberty where this was deemed necessary to ensure their safety.

People told us they were involved in decisions on how to manage any risks associated with their needs. One person told us how they were at risk of developing sore skin, this was discussed with them, and they were provided with a special mattress to reduce the risk of damage to their skin.

Staff told us they referred to care records which contained information on how to support and keep people safe. Changes in people’s needs were shared at meetings. Staff knew how to support people who were showing signs of distressed behaviour and followed guidance detailed in the person’s care records. The registered manager told us they were supported by the home care team to refer people to other agencies such as the speech and language therapy team, if they identified any changes or new risks.

The provider had a call bell system in place, which aimed to reduce noise levels when activated. However, this did not always work effectively. We became aware of the alarm being activated in 1 person’s room that staff had not responded to. We discussed this with the provider who promptly responded and put measures in place to address this. Staff understood people’s needs and supported them to maintain their safety. For example, we observed a member of staff encourage and support a person to mobilise with their walking aid.

People had care plans and risk assessments to guide staff on how to keep them safe. Systems were in place to ensure risks to people were assessed and monitored. Regular reviews took place to ensure measures were still appropriate and effective.

People were cared for and supported to live in a safe environment. One person said, “The manager and assistant manager will walk around every day and check how you are. They always check the buzzers are working”.

The registered manager understood their responsibilities for ensuring the environment was safe. They told us they conducted a daily walk around. Staff had completed training in health and safety and fire prevention and awareness.

Overall, the premises were well maintained, however, whilst we found no harm to people, we identified some safety concerns within the environment. For example, 2 microwaves were rusty, and cleaning chemicals stored in the communal dining room were not locked away, which meant people could easily gain access them. This increased the risk of harm to people. We discussed our findings with the provider and prompt action was taken to address all the safety concerns we identified. The environment was clean and tidy.

Systems were in place to check the safety of the environment, and equipment used to support people. However, the concerns we found had not been picked up by the providers systems and checks. It was not clear from the providers records if all staff had been involved in practicing fire drills in line with the providers policy and procedures, although fire drills were taking place. People had a up to date personal emergency evacuation plan (PEEP) in place these were reviewed and updated as people’s needs changed. Inspections by external agencies were carried out as required such as testing for legionella.

People and their relatives spoke positively about staff. One person said, “We can rely upon the staff to help us when we need it. A relative told us, “There are absolutely no concerns here, everyone is so safe and cared for”.

Staff received relevant training and supervision to support them in their role. New staff were given a planned induction when they started working for the service, which included shadowing an experienced member of staff. Most staff we spoke with felt there was enough staff to keep people safe. Comments included, “If we raise concerns about how many staff there are, the manager will respond and even come onto the floor if needed” and “There is enough staff most of the time, we all work together”.

We observed there were enough staff to support people during our visit. Some staff had come in voluntarily to support residents with dressing the Christmas trees.

Processes were in place to ensure staff were recruited safely. Pre-employment checks were completed before staff commenced work. This included a check with the Disclosure and Barring Service (DBS). Staffing levels were determined by people’s needs and a dependency tool used to calculate levels of staff required. Staff were deployed to ensure there were enough staff and an appropriate skill mix on each unit. Staff were inducted into the home and their knowledge maintained through ongoing learning and development.

People were supported to live in a clean environment. No concerns were raised by people or relatives about the cleanliness of the service.

Staff had received training on how to use and dispose of personal protective equipment (PPE) correctly and knew their responsibilities in relation to infection control. Staff told us they had access to adequate supplies of PPE.

The premises were clean. We saw that staff where required wore PPE in line with current guidance. Cleaning schedules were in place, we did identify some gaps on records, the provider had also identified this and had addressed the shortfalls with staff.

The provider had infection control policies in place and staff received training in infection prevention and control. Infection control audits were carried out routinely by the registered manager. Where shortfalls had been identified, appropriate actions were taken and recorded.

People did not raise any concerns regarding the management of their medicines.

Staff who administered medicines told us they had received training. The registered manager confirmed, and records showed that staff responsible for administering medicines had their competencies regularly assessed.

Systems were in place to monitor and manage medicines. However, on the first day of our assessment we found there were some missing instructions for the administration of ‘as required’ (PRN) medicines. We raised this with the management team. When we returned on the second day, we were told by the registered manager this information was now in place. Upon checking these we found 1 person’s protocol did not match the instructions on the prescription. However, instructions on the electronic system were accurate and this reduced the risk of a medicine error occurring, also care plans and risk assessments were in place to inform staff when to consider giving PRN medicines . We raised this with the registered manager who immediately took steps to ensure that only accurate information was available regarding the persons PRN medicine. Despite this we found areas of good practice. Controlled drugs (medicines that need additional measures to ensure they are stored safely and accounted for) were managed safely and there were clear systems for the storage, administration, returns and disposal of medicines. Stock counts were accurate and up to date.