Archived: Jasmine

Jasmine provides care and support for up to seven people who have learning disabilities and ¿physical disabilities. The home has two distinct areas. People who live in the main part of the ¿home require 24 hour staff support. There is a one bedroom self contained flat for people who are ¿more independent, which is used for short stays. There were seven people living at the home at ¿the time of our inspection. Six people lived in the main part of the home; one person lived in the ¿self contained flat.¿

A registered manager was responsible for the home. 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.¿

At the last inspection on 1 and 3 June 2015 we found the provider to be in breach of Regulations ¿¿9, 10, 12, 16 and 18 of The Health and Social Care Act 2008 (Regulated Activities) Regulations ¿¿2014. This was because people’s medicines were not well managed to ensure people received ¿them safely or effectively. People were not communicated with effectively and their choices were ¿limited. Staff practice was inconsistent and they were not well supported in their roles. People’s ¿independence was not supported. People were not always supported by staff they knew as staff ¿consistency and numbers varied. People’s care was not planned and delivered in line with their ¿current or changing needs. People’s care was not reviewed regularly. People’s activities and trips ¿out of the home were limited. There was a complaints procedure in place but complaints were not ¿well managed. We also found the provider to be in breach of Regulation 18 of the Care Quality ¿Commission (Registration) Regulations 2009. This was because the provider had failed to ensure ¿that they had notified us of all significant events as required by law.¿

We found the provider to be in breach of Regulation 17 of The Health and Social Care Act 2008 ¿¿(Regulated Activities) Regulations 2014. This was because people did not receive consistently ¿high quality care. There was a lack of consistent management and leadership of the service. The ¿systems in place designed to monitor the quality of the service and its compliance with the law ¿were not effective. After the inspection, we used our enforcement powers and served a Warning ¿Notice on the provider. This was a formal notice which confirmed the provider had to meet this ¿legal requirement by 11 November 2015.¿

We also recommended the provider reviewed guidance about best practice in and application of ¿the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards as people could not be ¿assured that others close to them were involved in making decisions for them if people were ¿unable to themselves.¿

At this latest inspection we found all the necessary improvements had been made. Our Warning ¿Notice had been complied with.¿

We spoke with one person at length about their service and had more limited communication with ¿two other people. We also used our observations and discussions with people's relatives and staff ¿to help form our judgements.¿

Staff understood people's needs and provided the care and support they needed. The home was ¿a safe place for people. One person said, ““It does feel safe living here. All of the staff are nice to ¿me.” One relative said, “It’s a safe place. We have no concerns about safety at all.”¿

People interacted well with staff. Staff knew people and understood their care and support needs. ¿People made choices about their own lives. Various forms of communication were used if people ¿were unable to use speech. People took part in various activities and trips, were part of their ¿community and were encouraged to be as independent as they could be.¿

Staffing levels were good and people received good support from health and social care ¿professionals whose advice was acted upon. People’s care was regularly reviewed.¿

Staff had built close, trusting relationships with people. One relative said, “All of the staff are just ¿so interested in [name]. They have really taken the time to get to know her.”¿

People, and those close to them, were involved in planning and reviewing their care and support. ¿There was a close relationship and good communication with people's relatives. Relatives felt ¿their views were listened to and acted on.¿

Staff were well supported and well trained. Staff morale was good. Staff spoke highly of the care ¿they were able to provide to people. One staff member said, “There has been a real focus on ¿person centred care. That’s what we aim for. It’s all about seeing each person as an individual.”¿

There was a management structure in the home, which provided clear lines of responsibility and ¿accountability. All staff worked hard to provide the best level of care possible to people. The aims ¿of the service were well defined and adopted by the staff team.¿

There were effective quality assurance processes in place to monitor care and safety and plan ¿ongoing improvements. There were systems in place to share information and seek people's ¿views about their care and the running of the home.¿

We considered the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is the summary of what we found:

On the day of our inspection at Jasmine there were five people living at the home. We spoke to two people living at the home, two relatives, a visting GP and six staff.

Is the service safe?

We observed that people were cared for in an environment that was safe, clean and hygienic. People who lived at the home were unable to fully express their views verbally. Two people responded "yes" when asked if they were happy living at the home. We noted that appropriate safeguarding arrangements were in place in the form of safeguarding and whistleblowing policies. All staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberties and we saw evidence of this in staff files and training records.

CQC monitors the operation of Deprivation of Liberties which applies to care homes. We noted that no application had been submitted and policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. This helped protect people's human rights.

We observed there were sufficient staff on duty to meet the needs of the people living at Jasmine. The registered manager was part of a senior managers on call rota in case of emergencies. We noted that staff records were accurate and complete. We saw evidence that staff had the skills and experience needed to support people in their care at the home. We observed that emergency procedures in place in the event of a fire and noted that fire evacuation training was up to date and documented in staff files.

Is the service effective?

We found the service was effective in meeting people's needs. We observed that people at the home appeared to be comfortable in the presence of staff and it was evident staff knew people really well. For example, people were pleased to see staff when they entered a room and would make physical contact with them if they were able to. Staff told us "We know people really well and are able to interpret their needs". We observed throughout the day that staff cared for people with kindness and respect and there was a cheerful and positive atmosphere amongst people and staff at the home. We saw the care records contained triggers and behaviours which would indicate to staff a person was becoming unwell. We noted the assessments contained clear guidance on how to prevent any relapse becoming a crisis.

Is the service caring?

We observed that people were cared for and attention had been paid to people's appearance. When people required personal care the person was taken to an appropriate environment which ensured the person's privacy and dignity needs were maintained. We saw the care records contained people's life stories which included people's family and friends, how people communicated and their daily routines and preferences. We saw risk assessment were in place to ensure that care that was delivered was safe. We saw from the care records staff had implemented the care recommendations from visiting professionals.

Is the service responsive?

We spoke to staff who told us it was essential to the care and wellbeing of people at the home to be responsive to their care and support needs which were constantly changing. Staff were skilled in communicating with people. We observed staff used each person's preferred style of communication to help people to choose the activities they wanted to participate in each day. We saw staff were able to recognise behaviours which may indicate the person was unhappy or distressed about doing something they did not want to do. We saw throughout our visit people were offered choices about what they would like to eat. Staff were patient and kind and spent a long time with people to ensure that people were able to choose what they wanted to eat.

Is the service well-led?

We observed that staff had a good understanding of the ethos of the home. They demonstrated throughout the visit how people were cared for and supported to live independent and full lives in line with their medical condition. We spoke to two relatives who told us "Our family member has been here for a long time and we cannot fault the care and support they have received at the home. The staff always keep us informed of any changes to our family member who although they cannot speak to us we know they are happy at the home". We spoke to a visiting GP who said "People at the home are well cared for and the staff do an excellent job in liaising with the right care services to support people's on going medical and psychological needs."

We noted that staff received regular supervision and in service training. This was recorded in staff files and on the electronic training records for the home. Staff told us they found the supervision sessions to be very "helpful" in enabling them to do their jobs well.

When we visited eight people were using the service. The people who lived at the home had complex needs and only two were able to engage in limited conversations with us. However, we were able to observe how staff interacted with people and we spoke to staff about the experiences of the people they supported.

The staff we spoke with demonstrated a very good understanding of how to support people to make decisions and of the procedures to follow where an individual lacked the capacity to consent to their care and treatment. This meant that people's human rights were protected.

The care plans we looked at promoted a very person centred approach to care. We found that people's heath needs had been appropriately monitored and that people had access to a range of health and social care professionals.

The majority of the people who lived at the home were unable to communicate verbally. Two people responded 'yes' when we asked them if they were happy living at the home.

At our last inspection we found that improvements were needed to some areas of the home's environment. At this inspection we found that the home now provided a comfortable, accessible and homely environment for the people living there.

Systems were in place to monitor and improve the quality of the service people received.

We were able to speak with two people who told us they were 'happy' living at the home and that staff listened to them. One person replied 'yes I do' when asked if they liked the staff who worked in the home.

People who lived in the home were well cared for. Two people were able to confirm that they were well cared for by staff. One person said it was 'alright living here' and that staff were 'kind'. People's care records showed they were supported by a range of health professionals such as their GP, dentist, occupational therapist and district nurse.

Staff told us 'one or two people' would be able to say if they were unhappy or if they did not feel safe. Other people who lived in the home would have difficulty in communicating this. None of the staff we spoke with had any concerns about any person being at risk and told us they felt the home was a safe place for people to live.

Some areas had been redecorated such as the lounge the toilet. Some areas still needed redecoration. There remained a lack of storage space. This meant that people were not provided with a consistently homely environment.