We carried out a review of the data available to us about J S Parker Limited North East on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about J S Parker Limited North East, you can give feedback on this service.
J S Parker Limited North East is a specialist brain and spinal injury case management and rehabilitation service. They offer assessment, case management, therapy services, staff training and support to adults and children with very complex care needs who live in their own home.
People’s experience of using this service and what we found
People received a tailor-made service from an exceptionally well-led team of staff. The registered manager and staff were extremely passionate and committed to providing high-quality, person-centred care.
The registered manager exhibited very strong leadership skills and excelled within the organisation to achieve consistently high standards. The service had continued to develop and improve. The organisation fully supported the service and demonstrated a solid corporate approach to driving up industry standards. Audits and checks were fully embedded into the service to monitor quality and safety.
People had accomplished remarkable goals and outcomes through outstanding support from staff. People lived fulfilled lives which were enriched by a huge variety of hobbies, activities and educational opportunities. People were supported to have maximum choice and control of their life and was supported in the least restrictive way possible.
Staff fully embraced the person-centred culture of the organisation and demonstrated exceptionally caring values. They were reliable, consistent and deeply dedicated to caring for people. Subsequently, people received a unique service which met all their needs and exceeded the expectations of their relatives and other professionals.
People had timely access to professional therapists to improve their health and well-being and promote independence. Staff worked in excellent partnership with other services to provide people with a unified service.
Case managers supported people to recruit their own staff. Carefully selected teams of well trained and extremely competent staff supported people to live their lives to the fullest. The recruitment process was safe, and staff benefitted from training which was individually designed to suit each person’s needs.
People were kept very safe. Positive risks which enhanced people’s quality of life were strongly encouraged. Robust measures were in place to reduce any potential risks. Staff proactively recognised areas of risks and signs of abuse and reported any concerns to the registered manager with confidence. Safeguarding policies and procedures were in place.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
At our last inspection this service was rated requires improvement (published on 30 January 2019).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor the information we receive about this service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service:
People and their relatives for the most part had a very positive experience of this service. They felt well supported by the case managers and the staff employed to deliver personal care.
We found where agency staff had been engaged, checklists to ensure they were suitable to work in the service had not been used. We made a recommendation about this.
It was drawn to our attention that whilst staff worked out of hours and overnight there was not an on-call service to support staff should they experience difficulties or become unwell. We made a recommendation about this.
Staff told us they felt supported through induction, training, supervision and appraisal. We found there was a supervision policy for staff who were directly employed by the provider. There was also a guidance sheet for staff who were employed by people using the service and who were delivering personal care. These staff were not routinely receiving 1:1 supervision. We made a recommendation about this.
Pre-employment checks were carried out on staff to see if they were suitable to work with people in their homes.
Case managers supported by occupational therapists and other professionals had drawn up person-centred care plans to guide staff providing personal care. Personal risks were identified and steps had been taken to reduce each person's risks. Relatives reported to us that staff engaged with other professionals and took their advice to meet people's needs. Case managers carried out reviews which ensured people's care plans were up-to-date
People's medicines were safely administered by staff who had been assessed as competent to do so.
Staff had been trained in safeguarding and understood how to report concerns.
Accidents and incidents were reviewed by case managers to prevent re-occurrences. Staff understood they were required to report these incidents as soon as possible.
Staff supported people to devise menus, shop for food and eat and drink in their own homes and in the community.
Case managers held team meetings around each person. Staff confirmed they attended these meetings. The minutes of the meetings showed staff were involved in planning people's care.
We checked whether the service was working within the principles of the MCA, whether any restrictions on people’s liberty had been authorised and whether any conditions on such authorisations were being met. Staff understood where restrictions were in place and their role in keeping people safe.
People and their relatives told us staff were kind and caring. They were complimentary about case managers and staff who provided personal care. Relatives spoke with us about staff being respectful towards them. Staff knew people well and told us about people's likes and dislikes. We observed them responding promptly to people's need and providing reassurance. They promoted people's independence.
Relatives told us communication between them and the staff was good. Arrangements were in place to ensure staff were kept up to date with relevant information about people's needs.
People were enabled by staff to participate in community based activities of their choice. Participation was supported by risk assessments and staff helped people maintain their routines.
Quality audits were carried out by the quality team. Actions to improve the quality of the service were identified and followed up. We found some areas which required further improvement
The service had raised funds to purchase defibrillators for local charities. They had also supported another local charity to get their message about the dangers of violence.
Rating at last inspection: Good (Report published June 2016)
Why we inspected: This was a planned inspection. It was scheduled based on the previous rating.
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
Our last inspection of the service was in July 2014 when the provider was found to be meeting all of the regulations that we assessed. This inspection took place on the 21 April 2016 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be present at the office to assist with our inspection. The inspection team consisted of one inspector. At the time of this inspection there were 42 people in receipt of personal care from the service.
A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the service since January 2015. 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.
People spoke very highly of the staff who supported them and said that they always felt safe in their presence and when they received care from them. Systems were in place to protect people from abuse and there were channels available through which staff could raise concerns. Historic safeguarding matters had been handled appropriately and referred on to either people’s social workers or the relevant local authority safeguarding team for investigation. Staff had been trained in safeguarding vulnerable adults and they recognised their own personal responsibility to report matters of a safeguarding nature.
People’s needs and risks that they were exposed to in their daily lives were assessed, documented and regularly reviewed. Medicines were managed appropriately and policies and procedures were in place support and guide staff. Staffing levels were determined by people's needs and each person had a team of staff who were recruited by the service, specifically to support them. Recruitment processes were thorough and included checks to ensure that staff employed were of good character, appropriately skilled and physically and mentally fit.
Staff training was well maintained and staff told us they felt supported by the registered manager and provider organisation. Supervisions and appraisals took place regularly as did individual staff team meetings for all each person in receipt of care. Staff told us they felt supported by management and could approach them at any time, about anything.
CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. There was evidence to show the service understood their legal responsibility under this act and that they assessed people’s capacity when their care commenced and on an on-going basis if necessary. Decisions that needed to be made in people’s best interests had been undertaken and thorough records about such decision making were maintained.
People reported that staff were very caring and supported them in a manner which promoted and protected their privacy, dignity and independence. People said they enjoyed kind and positive relationships with staff and they had continuity of care from the same members of the care staff team whenever possible, which they appreciated.
A complaints policy was in place and people told us they felt both comfortable and confident enough to complain, but they had not needed to do so. People’s views and those of their relatives, staff and professionals working with the service were gathered through surveys, meetings and supervision sessions.
The care delivered was person-centred as were records maintained about people's care needs and linked risk assessments. Records demonstrated that the provider was responsive to people’s needs whenever necessary. People were supported to access the services of external healthcare professionals if they needed help and support in this area.
The registered manager and provider organisation promoted an open culture and staff told us that they found the management of the service approachable as a result. The provider had clear visions and values and future plans in place about how the business was to develop. Audits and quality monitoring of the service delivered was robust and carried out regularly. Records showed that where any issues were identified these were addressed promptly.
We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;
' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found.
Is the service caring?
We saw that people were supported by attentive staff who displayed patience and gave encouragement when helping people. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required and the relationship between staff and people was good. Those people who could told us that they were happy with the care and support they received from the service and this was supported by the comments that their relatives made. One person said, "They are pretty good. I am happy with the care." One relative told us, "I am happy with everything at the moment thank you and the staff are fine."
People's diverse needs had been assessed and recorded appropriately in care and support plans developed in line with people's wishes for staff to refer to. Staff displayed knowledge which demonstrated that they were fully aware of people's care and support needs.
Staff told us, and people confirmed that they were supported to partake in activities in the community such as shopping, visiting coffee shops and swimming. This showed the provider promoted people's well-being.
Is the service responsive?
People's care needs and any potential risks that they may be exposed to were assessed before they received care and support from the provider. The provider had arrangements in place to review people's care records regularly and there was evidence to confirm this was done. We saw that amendments were made to people's documentation as their needs changed, to ensure this remained accurate and any issues were promptly addressed.
Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as occupational therapists, speech and language therapy teams or doctors, or where, for example, their weight or behaviours needed to be monitored, they received this care.
There was an effective complaints system in place. We found that people and their relatives felt confident in raising concerns with the regional manager, or any members of staff who in turn understood their responsibilities to escalate these concerns or complaints.
Is the service safe?
People told us they felt safe in relation to the standards of care and support that they received and in the presence of the staff who cared for them. The care that we observed during our inspection was delivered safely. Risks that people may be exposed to in their daily lives and in relation to their care needs had been considered. We saw that instructions had been drafted for staff to follow to ensure people remained as safe as possible in light of these identified risks.
People's nutritional needs were met appropriately and where there was a need for monitoring their weight, or fluid and food intake, this was done. We saw that where necessary people received input into their care from dieticians and speech and language therapists.
We reviewed the arrangements in place for the management of medicines including how medicines were obtained, stored, administered. We found that these arrangements were both appropriate and safe. Staff with responsibility for medication administration had been appropriately trained.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care providers. We discussed the recent Supreme Court judgement handed down on 19 March 2014 in the case of 'P v Cheshire West and Chester Council and another' and 'P and Q v Surrey County Council', about what constitutes a deprivation of liberty. The regional manager confirmed they will be contacting the relevant local safeguarding team in light of this judgement, for further advice on their responsibilities and the arrangements they now need to put in place, for one person in their care who requires a DoLS application to be submitted and assessed.
Is the service effective?
People told us they were happy with the staff who cared for them and they met their needs. One person said, "I am happy with the care." Another person told us, "Everything's great." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.
People who could told us they felt involved in their care and all of the relatives we spoke with told us they felt fully informed about their relation's care needs. One relative told us, "We talk about things and change things if need be. They discuss everything with me."
Is the service well-led?
The service worked well with other agencies and services to make sure people received their care in a joined up way.
An effective quality assurance system was in place which helped to ensure that people received a good quality service at all times, by monitoring care and addressing shortfalls promptly. The provider monitored the care that staff delivered.
Staff told us they were clear about their roles and responsibilities and they had a good understanding of the ethos of the service. The provider had a range of policies and procedures in place which gave direction and instruction to staff. A number of audits were carried out regularly, and the views of people and their relatives were gathered at set intervals to ascertain their opinions of the service they received. This showed the provider measured the effectiveness of the service they delivered and sought to protect people's welfare.
People told us their consent was obtained before care was delivered and staff acted in accordance with their wishes. Where people did not have the capacity to consent we found the provider acted in accordance with legal requirements.
We saw that people's care needs were assessed and their care and treatment was planned and delivered in line with their individual care plans.
We looked at how the home managed infection control and found that staff were aware of their responsibilities and followed appropriate guidance issued to them by the service.
We found the provider had a structured staff selection and recruitment policy in place which helped to ensure staff were suitably skilled, experienced and qualified to deliver care safely.
The service had effective measures in place to monitor the service they provided. There was a structured complaints policy and procedure in place and people said they would happily complain to their case manager if necessary.
At this inspection we also checked whether previous shortfalls in the maintenance of records had been addressed. These issues had been identified during our last inspection at the service on 20 October 2012. We found improvements had been made and the risks of people receiving inappropriate care because records were not suitably maintained, had been reduced.
We found that people felt safe when in receipt of care and staff were aware of their responsibilities in relation to protecting people from harm or abuse. Staff were appropriately trained and the service had adequate systems in place to monitor the quality of the service that it provided. However, although people who received care and support from J.S. Parker Limited North East told us they were happy and we saw they were well supported, we found that failures to maintain records appropriately may put people at risk.