Jalna Residential Care Home

We found the following examples of good practice.

There were enough stocks of personal protective equipment (PPE). PPE stations and hand sanitiser were available throughout the home which helped ensure staff and visitors had access to it when required. Staff had received training in the use of PPE, infection control and hand hygiene. We observed staff and management were using PPE correctly. Signage was in place to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

There were effective processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included regular testing of staff and people living in the home and testing of visitors to the home. Safe visiting processes were followed, and the vaccination status of all visitors was checked in accordance with the current COVID-19 guidance.

There was a good standard of cleanliness in all areas seen. Infection prevention and control policies and procedures were kept under review and monthly audits were carried out. Business continuity plans were in place. People were being admitted safely to the service in line with current guidance. There were sufficient staff to provide continuity of support should there be a staff shortage. All staff had access to appropriate support to manage their wellbeing should it be required.

Jalna Residential Care Home is a residential care home providing accommodation, care and support for up to 22 people aged 65 and over. The service does not provide nursing care. There were 18 people living at the home at the time of the inspection.

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

Systems and processes safeguarded people from the risk of abuse. People told us they felt safe and staff were confident the management team would act quickly to keep people safe. Everyone spoken with were complimentary about the staff team and the care and support provided. Effective systems were in place to ensure lessons were learnt from any incidents and the management team understood their responsibility to be open and honest when something went wrong.

Environmental risks and risks to people's health, safety and wellbeing were managed well and kept under review. Equipment was safe to use and regularly serviced and maintained. Recruitment processes ensured staff were suitable to work with vulnerable people; some additional improvements, to ensure the process was fully robust, were discussed with the registered manager. There were enough staff to meet people's needs and to ensure their safety.

The home was clean and odour free and staff followed safe infection control practices. Additional systems and guidance were in place to reduce the risk of infection during the pandemic; we suggested changes to the cleaning schedule, and this was complied with. The management of people’s medicines had improved, and they were managed safely. The service had equality and diversity policies and procedures in place. People’s privacy and dignity were respected.

People's care and support needs were assessed prior to them using the service to ensure their needs could be met; care records were reflective of the support they needed and received. They were supported to live healthy lives and had access to professionals, a well-trained staff team and a choice of a nutritious diet. The home worked in partnership with other organisations to provide effective and consistent care. 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.

The management team and staff had worked hard to address the shortfalls found at previous inspections and were clear about where further developments were needed. There were effective systems to check the quality of the service and to monitor staff practice with clear evidence improvements had taken place. People's views were sought about the service and acted on. Where possible, people were involved in decisions about their care and support. Care was planned in a person-centred way and regularly reviewed which helped ensure good outcomes for people; the registered manager told us further improvements were planned with this. Records were accurate and organised. The service engaged with external professionals to ensure people received prompt and coordinated care.

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

The last rating for this service was requires improvement (published 25 February 2020). There were breaches of regulation in relation to maintaining accurate records in relation to people’s care. We also made recommendations about medicines management. After the last inspection, the provider completed an action plan to show what they would do and by when, to improve.

At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an unannounced comprehensive inspection of this service on 9 May 2019, followed by a focused inspection on 28 August 2019 and 29 January 2020. Breaches of legal requirements were found.

We undertook this focused inspection on 16 December 2020, to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-Led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jalna Residential Care Home 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.

Jalna is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

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

We found significant improvements had been made to medication. However, we made some recommendations around fridge temperatures and storage of medicated creams.

Risk assessments did not always include appropriate strategies and we found conflicting information in care plans which were not always reflective of people's needs. This was a breach of regulation 17 (2) (c) Good governance. At the last inspection there had been a breach of regulation 17 (2) (b) in relation to monitoring and auditing, so this was a repeated breach of regulation 17 Good governance.

Improvements had been made to recruitment and the application forms had been changed following the last inspection to reflect a full employment history. However, we found some issues with references from previous care employment, which the manager chased up during the inspection. We made a recommendation around this.

People told us they felt safe and they were happy living at the home. One person said, "Its marvellous here for what I need. They look after me and bring me my meals." The home was clean and tidy. People told us staffing levels were appropriate.

The service had a new manager in place, who was in the process of applying to be the registered manager. Although she had not been in post long, we were reassured that some improvements had taken place. Audits, accidents and incidents analysis and statutory notifications were now taking place. Morale had improved at the service and one staff member told us, "I've never been trained as much and never been allowed to do as much. She's empowering! I've never been more happier in my work."

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

The last rating for this service was requires improvement (published 10 October 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to ongoing concerns from the last inspection. 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. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. 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 Jalna on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Jalna is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

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

We found that improvements were required to medication to improve the safety of administration. Although improvements had been made in some areas, progress had been slow. Safeguarding alerts had been raised around concerns relating medication not being in stock and errors occurring. Concerns around medication had been a recurrent theme and had been highlighted by professionals visiting the service.

Improvements around recruitment were still taking place at the time of the inspection. The application forms did not state a full employment history. However, the provider ensured that this was updated by the end of the inspection.

People told us they felt safe and the home was clean and was welcoming. The provider had invested in the service, purchasing new carpets. People told us they felt the staffing levels were generally appropriate.

The service did not currently have a registered manager in place. There had been difficulties retaining managers and the current manager was absent. The manager had told us at the last inspection that they would be implementing weekly and monthly audits. We saw little evidence of audits being undertaken. No analysis of accidents and incidents were taking place to identify patterns and themes. Statutory notifications to us were not taking place.

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

The last rating for this service was requires improvement (published 2 July 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about medicines and leadership. 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.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider has taken action to mitigate the risks and this has been effective.

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

Enforcement

We have identified breaches in relation to medicines and leadership at this inspection.

Please see the action we have told the provider to take at the end of this report.

Since the last inspection we identified that the provider had failed to display the correct rating on their website. This is being dealt with separately outside of the inspection process.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Jalna Residential Care Home is a residential home registered to provide accommodation and personal care for 22 people aged 65 and over. At the time of the inspection, 21 people lived at the home.

People's experience of using the service

People told us they felt safe and they were well cared for. They told us the staff were very kind. People liked living in the service and the home had a warm, friendly atmosphere. Staff understood how to safeguard people from abuse and report any concerns.

Recruitment was not managed safely. The application forms did not state a full employment history and we found references from previous care employment were not always taken up. We also found that improvements were required to medication to improve the safety of administration. Concerns around medication had been highlighted in the previous inspection and from professionals visiting the service.

The security of the building was a concern, as one person had wandered away from the home earlier in the year and was found by a member of the public. We observed that security measures put in place at the time of the incident were no longer in place. We were told that was due to advice from the fire service. We requested that the provider look into alternative systems which are compatible with fire regulations to ensure people were kept safe.

People told us the food was very good and they were supported to eat a nutritionally balanced diet. However, although people were given of choice of where to eat their meals, there were limited facilities for people to sit at dining tables. This meant that some people were sat in the same chairs for prolonged periods of time.

The home was clean and was welcoming. We observed some maintenance issues which were in the process of being resolved, such as a bathroom that was out of order. We looked at training records and noted that not all staff had completed the providers mandatory training. However, we were assured by the manager that appropriate training had been planned for all staff.

People told us the staff were very kind and thoughtful. We observed staff to be kind and caring. We saw they treated people with dignity and respect

Some activities were taking place and we observed a game of bingo during our inspection. However, some people told us that they wanted more to do more activities. We observed that the service was using technology effectively in that they had purchased an Alexa and people could play music of their choice from different eras.

People told us they felt the staffing levels were generally appropriate.

Staff monitored people's healthcare needs and ensured people had access to appropriate healthcare services. People were aware of how they could raise a complaint or concern if they needed to and had access to a complaints procedure.

The service did not currently have a registered manager in place. There had been difficulties retaining managers and a new manager had just started in post. At the time of the inspection, the manager was in the process of applying to CQC to be registered. We saw evidence of some recent audits being undertaken. Although accidents and incidents were recorded on the electronic system, there did not seem to be any analysis of incidents taking place to identify patterns and themes.

An informal on call system was not in place for out of hours. This needed to be formalised and the documented on the rota. Staff told us they felt supported and morale had improved at the service. All people we spoke with praised the new manager who they said was very approachable. People also spoke fondly of the providers who they said were also very supportive. The providers visited the home regularly and knew the people at the home well.

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

Rating at last inspection:

At the last inspection the service was rated good. (published 9 June 2018)

Why we inspected:

This inspection was prompted by information of concern.

Enforcement:

We have identified breaches in relation to medication and recruitment at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up:

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Jalna Residential Care Home provides accommodation and personal care for up to a maximum of 22 older people, some of whom are living with dementia. The service does not provide nursing care. At time of the inspection there were 22 people accommodated in the home.

At the last inspection in November 2015 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good. However, we made a recommendation regarding the safe management of people’s medicines.

People received their medicines when they needed them. Staff administering medicines had received training and supervision to do this safely. However, further improvements were needed to ensure people’s medicines were managed safely at all times.

People were happy with the care and support they received. They told us they were happy and did not have any complaints. Staff understood how to protect people from abuse. A safe and robust recruitment procedure was followed and arrangements were in place to make sure staff were trained and competent. People considered there were enough staff to support them and staffing levels were monitored to ensure sufficient staff were available.

The information in people's care plans was sufficiently detailed to ensure they were at the centre of their care and risks to people's health and safety had been identified and managed safely. Relevant health and social care professionals provided advice and support when people's needs changed.

People had choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff respected people's diversity and promoted people's right to be free from discrimination. People's dignity and privacy was respected and upheld and staff encouraged people to be as independent as possible. The home was a clean, safe and comfortable place for people to live in with further improvements planned.

People's nutritional needs were monitored and reviewed and people were given a choice of meals. People had access to a range of appropriate activities. There were effective systems for assessing, monitoring and developing the quality of the service being provided to people. People and their relatives were consulted around their care and support and their views were acted upon.

Further information is in the detailed findings below.

Jalna Residential Care Home is registered to provide care for up to 22 people. The home was registered with the Commission to provide personal care for older people. At the time of our inspection there were 19 people in receipt of care from the provider.

The registration requirements for the provider stated the home should have a registered manager in place. There was a home manager in post on the day of our inspection and we were aware that the Commission had received a registered manager’s application from them to register. 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.

We last visited the service on 21, 22 and 23 April 2015 and identified breaches of regulation 12, 13 and 17 of HSCA (RA) Regulations 2014. We asked the provider to send us an action plan which told us when they would be complaint by 3 August 2015. We followed up these actions at this inspection. We also took enforcement action in respect of regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment. We told the provider they had to be complaint with this regulation by 27 July 2015 and followed up these actions at this inspection.

During our inspection we observed part of the lunchtime medication round. We saw that medications were administered in a safe way. We looked at the medications trolley and saw medicines were stored safely and medication administration charts we checked had been completed accurately and fully.

As a result of the last inspection the manager told us they had held a team meeting to discuss the process for reporting safeguarding concerns with all the staff. We were told staff had undertaken training in safeguarding and staff we spoke with was able to discuss the actions to take to deal with allegations of abuse. People we spoke with told us they felt safe in the home.

The manager told us they had introduced a new computer system to complete risk assessments, we saw evidence of risk assessments in place.

As a result of our last inspection the provider had implemented the use of a master key for people’s bedrooms. This would ensure staff had access to people’s bedrooms in the event of an emergency.

People we spoke with told us they enjoyed the choices of meals on offer. We sampled the lunch time meal, there were two choices available for people and included two courses. We saw that there were enough supplies of fresh and frozen food available in the home.

During our inspection we undertook a tour of the building. We checked people’s bedrooms and saw evidence of personal mementoes in them. We spoke with the manager about the temperature in one of the bedrooms as it was cooler than others. We were told windows were opened and radiators were switched off when people went to the main lounge and then put back on before people went back to their rooms. We monitored this room during or inspection and noted the temperature increased when the radiator was switched on.

We saw staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), records indicated saw staff had undertaken recent training in DoLS and dementia.

Staff were observed engaging in positive and meaningful relationships with people who used the service. It was clear that staff had knowledge of people’s individual needs and preferences and assisted people in and timely manner. People who used the service told us staff were kind and caring and gave positive feedback about the home, the staff and the delivery of care they received.

We saw that the provider investigated complaints. Records indicated actions taken as a result of complaints.

We received mixed feedback about people’s involvements in development of their care files. Care files included personal information, care plans and risk assessments in them. Records indicated these had been reviewed recently and reflected individual needs.

We received very positive feedback about the manager. Examples of comments received were, [name of manager] is really nice, she has made changes for the better, she is supportive”, “I have no worries, I would speak to the manager. She is lovely approachable you can talk to her.”

Evidence of improvements in the quality monitoring was noted as well as notes for actions to take forward as a result of the reviews. Completed audits were seen along with dates and actions identified as a result of them.

Staff confirmed team meetings were taking place and that they were able to voice their opinions. We saw evidence of minutes from staff meetings, these included attendees and notes taken.

We saw evidence of supervision taking place and staff told us they had received supervision recently.

Following our inspection the registered manager wrote to us and told us that they would review the way complaints and concerns were managed.

We spoke with four people who used the service and they told us they were happy with the support they received and the way staff responded to them. People told us:

"All the girls are lovely and look after me".

"They are quiet and patient with me and very caring."

"I would feel quite sure that if I was unhappy with anything the staff would do their best to put it right."

We met with the providers who showed us the newly introduced complaints recoding form and we confirmed with them that a new complaints procedure had been introduced, a copy of which was seen in the reception area of the home. We informed that the new procedure had also been placed in each bedroom.

During this inspection we found that all areas of non compliance identified at the previous inspection had been addressed.

You can see our judgements on the front page of this report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This a summary of what we found:

Is the service safe?

Staff had received appropriate training to care for people living in the home. They had access to policies and procedure for safeguarding vulnerable adults. Some of the staff we spoke with were able to discuss appropriate steps if there were concerns about a person's mental capacity.(The Mental Capacity Act provides a legal framework to protect people who need to be deprived of their liberty for their own safety). The manager told us there had been no applications made under the Act to deprive people of their liberty.

There were enough appropriately skilled staff in place to care for the needs of people who used the service. We saw the manager monitored staffing numbers and a needs analysis was carried out regularly to ensure staffing ratios were adequate.

Is the service caring?

We observed staff were kind and caring towards the people who used the service. There was a relaxed and friendly interaction between them. There was evidence of staff carrying out care and activities with people and we observed people being spoken to in respectful and kind manner.

We spoke with people living in the home and asked them if staff sat and chatted with them. We were told they were, 'Too busy' or, 'Didn't have time'. However all people spoken with were complementary about the care they received. Examples of comments received were, 'I am happy with the care, I can't really grumble the owners make sure everything is right'.

We looked around the home and in some people's bedrooms. We noted people's bedrooms contained personal items and mementoes. There was a homely atmosphere and we saw there were books and magazines in the small lounge for people to use.

Staff had received training to meet the needs of people who used the service including handling medication, moving and handling, health and safety and first aid. We were told there was an ongoing training programme in place and we saw evidence of plans for future updates including safeguarding.

The care files we looked at detailed the person's care needs, likes and dislikes and we saw evidence of regular review.

Is the service responsive?

We saw evidence of completed satisfaction questionnaires by people living in the home. There was evidence of complementary feedback.

We looked at the complaints file and saw that no complaints had been recorded. However we spoke with the relatives of people living in the home who told us of previous complaints. A person living in the home also identified concerns that had been brought to attention of the staff. However, their concerns had not been reported to the manager and none of the issues had been recorded. This meant we were unclear what action had been taken to address the people's concerns. We have asked the provider to provide us with a response on how these complaints will be dealt with.

Is the service effective?

We saw evidence that people who used the service were involved in decisions about the planning and delivery of their care. Whilst people could not recall discussing their care needs, we noted they had signed their care plans to indicate their participation and agreement. .

We saw evidence of people's health being monitored and appropriate intervention by professionals such as the district nurse of the GP.

We looked at menu choices for people living in the home and saw choice and variety were available. There were adequate supplies of food in the home and we saw evidence staff documented dietary intake.. Staff spoken with were able to discuss appropriate procedures in place to deal with any concerns in relation to dietary needs.

There was evidence of some activities taking place and we observed an activity on the day of our inspection. People had recorded they liked the activities in completed quality audits.

We observed there were some areas of the home cooler than the main lounge areas. We asked the manger about this who told us during the day staff opened bedroom windows and turned the radiators down. We were told if people wanted to return to their rooms staff would ensure the room was warm prior to them returning. We spoke with one person sitting in their bedroom at the time of our inspection who confirmed their room was always warm. We noted the bedroom was a comfortable temperature and the radiator was on.

Is the service well led?

There were systems in place to regularly assess and monitor the quality of the service.

The manager is registered with the Care Quality Commission and takes responsibility for the home. We were told the owners were closely involved in the home and provided excellent support to the manager. Some of the staff spoken with were positive about the support they received from the manager and we saw evidence of positive feedback to staff about effective care from the providers. However some other staff told us the manager was unsupportive.

There was evidence of supervision taking place however we noted the records were brief and lacked details of the action, outcomes and opportunities for staff.

We reviewed the care files of four people who lived in Jalna. We saw that care plans identified the needs of the person and included some information on how they wished their care to be delivered.

We found that arrangements had been implemented to safeguard people's finances and policies and procedures had been updated.

We spoke with three members of staff who told us they felt supported and confident in carrying out their responsibilities. We saw evidence there were sufficient, suitably qualified staff on duty during our visit.

We found that there were systems in place to monitor the quality of the service being provided.

People told us they had a good relationship with most of the staff at the home and the home was very clean. However people told us they were not always involved or consulted with about their care and treatment whilst living at Jalna. People also told us they had not had a resident meeting for some time and one person told us, 'It would be a good idea to have regular meetings to air our views'.

We found that suitable arrangements had not been implemented to manage people's finances.

Appropriate arrangements had been made to ensure people were protected from the unsafe management of medication, however regular checks and audits had not been put in place.

We found that some checks had been put in place to monitor the care and treatment provided and risk assessments had been completed. Effective systems had not been implemented to regularly monitor, assess and review the quality of service that people received.