JM Carehomes Limited

JM Carehomes Limited is a domiciliary care service which offers personal care and assistance to support people living in supported accommodation. The service supports people over 11 houses in the community and at the time of our inspection there were 40 people using the service.

The service has been developed and designed in line with the principles and values of Registering the Right Support and good practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning difficulties and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Not everyone who used the service received personal care. 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.

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

People were safeguarded from the potential of harm and their freedoms protected. Potential risks to people had been assessed and managed appropriately by the registered manager. People received their medicines safely and as prescribed and people were supported by sufficient numbers of staff to ensure that risk of harm was minimised.

Staff had been recruited appropriately and had received relevant training, so they were able to support people with their individual care and support needs. Staff received supervision and a yearly appraisal to support them to develop their careers and provide the support people required.

Staff sought people’s consent before providing care and support. 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.

People were treated with understanding, kindness and compassion. People’s rights to privacy were respected by the staff who supported them to maintain their dignity. People were supported to express their views and encouraged to be actively involved in making decisions about their care and support needs.

Each person had a care plan based upon an assessment of their needs which was regularly reviewed. The care plan included personal details about the persons choices for food and how they wished to live and be supported. People using the service were aware of the complaints process and were confident about approaching the registered manager and senor staff if they needed to.

There were effective auditing systems in place to monitor the quality of service provision. The views of people on about the service was gathered and used to support service development. The service worked closely with other professionals to support people using the service.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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)

At our last inspection in March 2017 we rated the service as good. The report was published on 26 April 2017.

Why we inspected

This was a planned inspection based on the previous rating and the inspection was also prompted in part due to concerns received about a safeguarding referral. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern.

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.

The service has 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.

People were safeguarded from the potential of harm and their freedoms protected. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff had received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people. The service worked well with other professionals to ensure that people's health needs were met. Where appropriate, support and guidance were sought from health care professionals, including GPs and mental health professionals. People were supported with their nutrition and hydration needs. Staff supported people with their medication when required.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. Staff were attentive to people's needs and treated people with dignity and respect.

People were supported with activities which interested them. People and their representatives knew how to make a complaint and the service had processes in place to deal with these.

The registered manager had a number of ways of gathering people’s views including talking with people, staff, and relatives. In addition the registered manager also gained people’s views by the use of questionnaires. Quality monitoring audits were completed to help ensure the service was running effectively and to make improvements.

This is a summary of what we found;

Is the service safe?

We found that the care records had been completed and detailed information was provided for people's individual needs. This provided staff with information on how to care form people in a safe way.

People told us that they felt safe and happy with the service they received from JM Carehomes Limited.

We saw that the care workers had been provided with training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff had been provided with the information they needed which would help to ensure that people were safeguarded from abuse.

Is the service effective?

People told us that, overall, their care needs were met at the service. People said that they were provided the assistance they required and that they had enough staff to help them.

Is the service caring?

We observed staff treating people respectfully. People told us that the staff were kind and caring.

Is the service responsive?

People told us that the service was responsive to their needs. The care plans had been updated to reflect people's changing needs.

Is the service well-led?

The registered manager was at the service on the day of the inspection. Staff we spoke to told us that the manager was approachable and supportive.

The registered manager had completed audits of the service, these also included surveys completed by relatives and people who used the service. This meant that people's views were taken into account.

We found that people who were using the service were protected against the risks associated with medicines. This was because there were arrangements for ensuring that medicines were available and administered as prescribed. Medicines were stored appropriately and safely. Checks were carried out to ensure that medicines were managed safely within the service.

We found that there were appropriate arrangements in place for recruiting staff robustly and safely so as to help ensure that people using the service received safe and appropriate care. We saw that all of the required checks including employment references and Disclosure and Barring Services (DBS) disclosures were obtained.

We found that the required improvements had been made in respect of the concerns we identified when we last visited the service.

We looked at care records for five people who used the service. We found they were offered support at a level which encouraged independence and ensured their individual needs were met. However we found medication systems were insufficient to ensure medication was always administered safely.

People told us most staff were friendly and courteous in their approach, and we found staff to be knowledgeable and confident in their roles. Staff records showed appropriate training was in place, however the recruitment processes were not always followed consistently.

We reviewed the providers' systems for managing safeguarding and keeping people safe. There were policies and procedures in place, and the staff we spoke with, were familiar with the processes they should follow.

The provider welcomed suggestions from people to improve the service they provided, and people said they felt able to approach the manager to discuss anything. They were confident that action would be taken to resolve any issues they had.

Our visit showed that appropriate arrangements were in place for people to have a plan detailing their support needs and how these were to be met by support staff. We also found that suitable arrangements were in place to protect people from abuse, neglect and self harm. In addition we found that there were systems in place to assess and monitor the quality of the service.