Chiltern Jigsaw Resource Centre

About the service

Chiltern Jigsaw Resource Centre provides a supported living service for people with a learning disability or autistic spectrum disorder. The service provided care and support to people living in 5 small ‘supported living’ settings, where people were supported to live as independently as possible. 1 of them was in Harrow and 2 were in Barnet. At the time of the inspection there were 25 people using the service, of which 20 were receiving personal care.

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

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support:

The service supported people to have the maximum possible choice, control and independence so they had control over their own lives. The service gave people care and support in a safe, clean, well equipped, well-furnished, and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. Staff enabled people to access specialist health and social care support in the community.

Right care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their treatment because staff had the necessary skills to understand them. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right culture:

People received good care and support because trained staff and specialists could meet their needs and wishes. Staff knew and understood people well. People and those important to them, including families, were involved in planning their care. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

They had identified the need to develop a better link with their partners, including families and significant others of the people they supported. They had developed partner liaison single point of contact within the organisation that was going to focus on ensuring that concerns were correctly identified and addressed in a timely manner.

People lived safely and free from unwarranted restrictions because the provider assessed, monitored, and managed safety well. The assessments provided information about how to support people to ensure risks were reduced but did not limit people’s right to take reasonable risks.

The service had enough staff, including for one-to-one support for people. The numbers and skills of staff matched the needs of people using the service.

People received their medicines safely. They were supported by staff who followed systems and processes to administer, record and store medicines safely. We observed from records people received their medicines on time.

People were protected from the risks associated with poor infection control because the service used effective infection, prevention and control measures to keep people, staff and visitors were safe.

People's health needs were met. The care files we looked at included details of health action plans and management of day-to-day healthcare needs.

There was a process in place to report, monitor and learn from accidents and incidents.

Governance processes were effective and helped to assess, monitor, and check the quality of the service provided to people. Audits had been carried out on a range of areas critical to the delivery of care.

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

Rating at last inspection

The last rating for this service was requires improvement (published 28 August 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Chiltern Jigsaw Resource Centre provides a supported living service for people with a learning disability or autistic spectrum disorder. The service provided care and support to people living in three small ‘supported living’ settings, where people were supported to live as independently as possible. One of them was in Harrow and two were in Barnet. At the time of this inspection the service provided care for a total of 11 people. The service also provided personal care for one person living in their own home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best 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 disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service aimed at ensuring that people receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

At the last comprehensive inspection in 24 July 2018 we found one breach in relation to Regulation17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance. The registered provider did not have an adequate system of comprehensive and regular quality monitoring checks and audits. This may put people at risk of harm or of not receiving appropriate care. During our responsive inspection on 1 March 2019, we found that although improvements had been made, there were still some areas where further improvements were needed. Therefore, the service continued to be rated as “Requires Improvement” overall.

People’s experience of using this service

People and their relatives told us they were satisfied with the care provided. They stated that staff treated them with respect and dignity and they felt safe in the home. We observed that staff interacted well with people and were caring and attentive towards them. Staff made effort to ensure that people's individual needs and preferences were responded to.

Risk assessments had been documented. Risks to people’s health and wellbeing had been assessed. There was guidance for staff on how to minimise risks to people.

Staff had received training on how to safeguard people and were aware of the procedure to follow if they suspected that people were subject to abuse. A number of safeguarding allegations were made against the service. These relate to concerns regarding the management and care provided at one of their supported living schemes. The service had taken action in response to concerns raised and significant improvements had been made.

People received their prescribed medicines. Staff had received medicines administration training and knew how to administer medicines safely. However, in one instance a person's medicines administration record (MAR) chart had not been signed promptly. This was rectified on the same day.

Staff had been carefully recruited and essential pre-employment checks had been carried out. The service had adequate staffing levels and staff were able to attend to people’s needs.

People and their relatives told us that staff observed hygienic practices and had assisted people to keep their home clean and tidy.

Staff supported people to have a healthy and nutritious diet that was in line with their individual dietary needs and preferences.

The healthcare needs of people had been assessed. Staff supported people in accessing the services of healthcare professionals when needed.

Staff had received training and had knowledge and skills to support people. The managers provided staff with regular supervision and a yearly appraisal of their performance.

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 services supported this practice. However, one person whose liberty was restricted was still awaiting a Court of Protection authorisation. The registered manager informed us soon after the inspection that the local authority was in the process of applying for the authorisation.

People’s specific care needs had been assessed prior to them receiving services. This enabled the service to provide person-centred care. There were arrangements for meeting the diverse needs of people. This included ensuring that people were supported with their individual, religious and cultural needs. Staff supported people to participate in various social and therapeutic activities within the community. This ensured that people remained as independent as possible.

There was a complaints procedure and people knew how to complain. Complaints recorded had been promptly responded to.

The provider had made significant improvements in managing the service. Morale among staff was good. Relatives provided positive feedback about the service. Staff had kept them informed of people’s progress. A more detailed quality monitoring system was in place. We however, noted that further improvements were needed to establish an effective quality monitoring system. The service need to have a consistent track record of identifying deficiencies and promptly rectifying them. The service had taken action in response to suggestions made in a recent satisfaction survey.

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

Rating at last inspection: The last rating for this service was requires improvement (published 9 April 2019).

Why we inspected: This was a planned inspection based on the previous rating.

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.

As a result of the information received, we undertook a focussed unannounced inspection on 1 March 2019. This report only covers our findings in relation to those topics and requirements we made in the last inspection report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chiltern Jigsaw Resource Centre on our website at www.cqc.org.uk”

Chiltern Jigsaw Resource Centre is a supported living service for people with a learning disability or autistic spectrum disorder. This service provided care and support to people living in three ‘supported living’ settings, where people were supported to live as independently as possible. One of them was in Harrow and two were in Barnet. At the time of this inspection the service provided care for a total of 11 people.

People’s care and housing are provided under separate contractual agreements. The Care Quality Commission [CQC] does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Chiltern Jigsaw Resource Centre received a regulated activity; CQC only inspected the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the last inspection we found one breach in relation to Regulation17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance. The registered provider did not have an adequate system of comprehensive and regular quality monitoring checks and audits. This may put people at risk of harm or of not receiving appropriate care.

During this inspection in March 2019, we found that although improvements had been made and some deficient areas rectified, there were still some areas where further improvements are needed. Therefore, the service continues to be rated as “Requires Improvement” overall.

We looked at the arrangements for safeguarding people. The service had a safeguarding policy and a whistle blowing policy to ensure that people were protected from harm and abuse. Care workers we spoke with had been provided with training on safeguarding people and knew what action to take if they were aware that people were being abused.

There were arrangements for the administration of medicines. Medicine administration record charts (MAR) and the controlled drugs register had been properly completed. Medicine audits had been carried out. The service had guidance for care workers on when they could administer as required medicines.

Risk assessments had been prepared for people. These contained guidance for minimising potential risks such as risks associated with neglect and behaviour which challenged the service. Care workers were aware of triggers that may cause people to be upset and action to take when people exhibited such behaviour.

There were sufficient care workers during the day shifts to attend to people’s care needs. However, during the night shifts there were insufficient care workers to ensure the safety of people. This was rectified soon after the inspection.

With one exception, the premises were kept clean. One window sill in the bathroom was not clean. The new manager stated that it would be cleaned soon.

Checks and audits of the service had been carried out by the Operations and Business Development Manager and other senior staff of the company. Checks had been carried out weekly and these included checks of the premises, care records and medicines. Audits had been carried out monthly and these included areas such as accidents, complaints, medicines and health and safety arrangements. These had identified deficiencies and action had been taken to rectify them. We however, noted that these audits were not sufficiently effective as they did not identify and promptly rectify the deficiencies noted by us.

The service had a comprehensive action plan which addressed concerns raised by the local authority and in complaints received. A manager had been allocated for overseeing the care provided at the supported living accommodation where there had been concerns. In addition, the service had recruited a new quality monitoring manager.

People’s care and housing are provided under separate contractual agreements. The Care Quality Commission [CQC] does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Chiltern Jigsaw Resource Centre received a regulated activity; CQC only inspected the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service were supported to live as ordinary a life as any citizen.

There was a registered manager in post at the service. A registered manager is a person who has registered with the CQC 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 our last comprehensive inspection on 16 and 18 May 2017 we rated the service as “Good”. We however, made a recommendation for improvements in quality monitoring in Well Led. During this inspection, we noted that the service did not have evidence of comprehensive and regular quality monitoring of the care provided. As a consequence some deficiencies were not identified and promptly responded to. This may put people at risk of harm or of not receiving appropriate care. We have therefore made a requirement in respect of this deficiency. Careful quality monitoring is essential to ensure that the service is well managed and deficiencies can be promptly attended to.

People who used the service informed us that they were satisfied with the care and services provided. They stated that they had been treated with respect and felt safe with care workers. There was a safeguarding adults' policy and suitable arrangements for safeguarding people. The service kept a record of safeguarding incidents and had co-operated with the safeguarding investigations in ensuring the protection of people. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Potential risks to people had been assessed and strategies were in place to mitigate against these risks. Personal emergency and evacuation plans (PEEPs) were prepared for people. This ensured that care workers were aware of action to take to ensure the safety of people in an emergency.

Infection control measures were in place. Care workers assisted people in ensuring that their bedrooms and communal areas were kept clean and tidy. The service kept a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, fire training and risk assessments.

Care workers were carefully recruited. There was a recruitment procedure and staff records contained evidence that essential checks had been carried out prior to care workers starting work. There were enough care workers deployed to meet people's needs. They had received essential training and were knowledgeable regarding the needs of people. Care workers had been provided with support and supervision.

An incident had occurred in which a care worker an injury. This had not been promptly reported to the Health & Safety Executive (HSE) in accordance with the Reporting of Injuries, Death and Dangerous Occurrences Regulations. Failure to do this may adversely affect the care provided for people. This was done soon after the inspection.

People’s healthcare needs were monitored and arrangements made for these needs to be attended to by healthcare professionals when required. The service had arrangements for assisting people with their dietary needs.

Meetings had been held where people or their representatives had opportunity to express their views and experiences regarding the care provided. The choices and preferences of people had been responded to. Care workers prepared appropriate and informative care plans which involved people and their representatives. The care provided had been reviewed with people and their representatives to ensure the changing needs of people were met. People had access to suitable activities in the community. This ensured that they received social and mental stimulation. Feedback received indicated that the service had been able to work with people with very complex needs and assist them in improving their mental state and general well-being.

The service had a complaints procedure. People and their representatives knew who to complain to if they had concerns. Two complaints did not contain the date they were received. The registered manager explained that they were received on the same day they were responded to.

People who used the service, relatives and care workers expressed confidence in the management of the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

At our last comprehensive inspection on 13 and 17 May 2016 we rated the service as “Requires Improvement”. We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach was in respect of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment. The registered provider did not do all that was reasonably possible to mitigate against health & safety risks to people. During this inspection, the provider demonstrated that they had taken remedial action to comply with the requirement made. Fire safety arrangements and PEEPS (personal emergency and evacuation plans) were in place and regular checks of the hot water temperatures had been recorded. The second breach was in respect of Regulation 9 relating to Person-centred care. The provider had not ensured that the service only accepted people it could adequately care for. During this inspection, we found that there were arrangements to ensure that people were carefully assessed so that their needs could be met. The third breach was in respect of Regulation 17 relating to good governance. The service did not have effective quality assurance systems for assessing, monitoring and improving the quality of the service. During this inspection, we saw evidence of improvements made. These included a centralised system of audits on medicines, complaints and incidents. We however, noted that that further improvements were needed to ensure that deficiencies were promptly identified and responded to. We have asked th provider to send us an action plan setting out how they will address this.

People who used the service informed us that they were satisfied with the care and services provided. They stated that they had been treated with respect and felt safe with care workers. There was a safeguarding adult's policy and suitable arrangements for safeguarding people. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. People’s care needs and potential risks to them were assessed and documented. Personal emergency and evacuation plans (PEEPs) were prepared for people. This ensured that care workers were aware of action to take to ensure the safety of people.

The service had arrangements for Infection control. Care workers assisted people in ensuring that their bedrooms and communal areas were kept clean and tidy. The service kept a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, staff fire training and risk assessments.

There was a recruitment procedure to ensure that care workers were carefully recruited. There were enough care workers deployed to meet people's needs. They had received essential training and were knowledgeable regarding the needs of people. Arrangements were in place to ensure teamwork and effective communication. Care workers had been provided with support and supervision.

People’s healthcare needs were monitored and arrangements had been made with healthcare professionals when required. The service had arrangements for assisting people with their dietary needs. There were arrangements for encouraging people to express their views and experiences regarding the care provided and management of the service. Care workers prepared appropriate and informative care plans which involved people and their representatives. Regular meetings and one to one sessions had been held for people and the minutes were available for inspection. The care provided had been reviewed to ensure the needs of people were met.

The service assisted people in accessing suitable activities in the community. This ensured that they received social and mental stimulation. People knew who to complain to if they had concerns.

Audits and checks of the service had been carried out by the previous registered manager and senior staff of the company. We however, noted that a small number of deficiencies were not noted in the audits. In addition, we received feedback from one relative and two care professionals that communication with the service was not always good. The new manager informed us that the service had a communication procedure and they would be monitoring this area to ensure to ensure that request for information are promptly responded to. After the inspection, the service provided us with details of action they were taking to improve communication and audits carried out.

Care workers worked well together and they had confidence in the management of the service. They were aware of the values and aims of the service and this included treating people with respect and dignity and encouraging them to be as independent as possible.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

The service had provided care for some people with complex and mental healthcare needs. This meant that some of them required support which other services may not be able to provide. The statement of purpose for the service indicated that they were willing to provide care for people and support them to live as independent a life as possible.

People who used the service and their representatives stated that people had been treated with respect and dignity. The service had a safeguarding adults policy and care workers had received training in safeguarding people. Potential risks to people were assessed and guidance provided to care workers for minimising these risks. People had been given their medicines and no unexplained gaps were noted in their medicines administration charts. We however, noted that the fire safety arrangements were inadequate as PEEPS (personal emergency and evacuation plans) were not in place and there was no documented evidence of weekly fire alarm checks. Regular checks of the hot water temperatures had not been recorded. These measures were needed to ensure the safety of people. These were put in place soon after our visit.

The registered manager and director informed us that the service had undergone a re-organisation of its care workers recently as part of the development plan of the company. This had meant that some care workers had been moved to other supported living units and additional new care workers were recruited. We examined the recruitment records. The records indicated that care workers had been carefully recruited. Care workers had received appropriate training to ensure that they had the skills and knowledge to care for people. They were knowledgeable regarding people’s needs and preferences. Care workers said there was a good staff team. Staff supervision and annual appraisals had been carried out. These ensured that care workers were supported. People informed us that there was sufficient care workers to attend to their needs. In one instance we noted that there was insufficient care workers during the night in one of the places we visited. The registered manager stated that extra care workers had not been commissioned by the care purchasers. They however, informed us soon after the inspection that extra staff had been provided while awaiting funding for extra care workers.

People’s needs had been assessed and detailed care plans were prepared with the involvement of people and their representatives. The provider had employed a behavioural intervention specialist to support care workers in care planning. Reviews of care had been carried out to ensure that the care provided was relevant. People’s physical and mental healthcare needs were monitored and they had access to health and social care professionals to ensure they received treatment and support for their specific needs. Two relatives and four social and healthcare professionals however, stated that the care needs of people had not been met. Two professionals stated that the service had been able to make improvements in the care of the clients. One professional stated that their client had become settled following concerns expressed. One person informed us that they had made progress and had been able to find a job. The registered manager explained that there had been a re-organisation of care workers and new care workers had also been recruited. He added that there was an action plan to improve the care provided.

The service had a complaints procedure and people knew how to make a complaint. We however, noted that the complaints record was not sufficiently comprehensive or accurate. One relative and a person who used the service stated that the service did not respond promptly to complaints made. The registered manager acknowledged that improvements were needed. He stated that the service was in the process of collating all complaints so that there was a comprehensive centralised system for effectively responding to complaints.

Feedback had been sought from people and their representatives and the last satisfaction survey indicated that people and their representatives were positive about the service. We, however noted that the service did not have sufficiently comprehensive and regular audits and checks. The health & safety checks by the registered manager for one of the schemes was only documented six monthly and did not identify important fire safety deficiencies we noted. There was no record of recent audits of medicines so that deficiencies can be promptly identified and rectified.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

One person and three relatives informed us that they were satisfied with the care and services provided. They informed us that that people who used the service were treated with respect and dignity. The service had arrangements to ensure people were safe. There was a safeguarding adults policy and suitable arrangements for safeguarding people. Potential risks to people were assessed and guidance provided to staff for minimising these risks.

People had been given their medicines and the arrangements for medicines administration was satisfactory. There was a medicines policy and procedure to provide guidance for staff.

There were measures were in place for infection control and staff were aware of procedures to

prevent infection. Protective equipment and hand gel were available.

We saw that there were sufficient staff on duty and they interacted well with people. The staff records indicated that staff had been carefully recruited. Staff had received appropriate training to ensure that they had the skills and knowledge to care for people. They were knowledgeable regarding people’s needs and preferences. Staff supervision and annual appraisals had been carried out. These ensured that staff were supported. A staff member stated that there were times when they were disturbed when they were on “sleeping in duty” and this meant that they were tired when they had to be on duty the next day. The registered manager stated that they had arrangements whereby staff could inform them if they were disturbed during the night and alternative staffing arrangements could be arranged. He agreed to remind staff of this arrangement. A member of staff had worked excessive hours. This may place people and the staff concerned at risk. The registered manager and human resources manager agreed that the staffing arrangements would be carefully planned in future and closely monitored so that this would not re-occur.

People’s needs had been assessed and detailed care plans were prepared with the involvement of people and their representatives. Regular reviews of care had been carried out to ensure that the care provided was relevant. Their physical and mental health needs were monitored and they had access to health and social care professionals to ensure they received treatment and support for their specific needs.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the service. Consultation meetings had been held for people and their representatives. People were encouraged to be as independent as possible and enabled to do their own shopping and prepare their own meals with assistance from staff. The service had an activities programme and a sensory room to provide social interaction and therapeutic stimulation for people.

Staff were aware of the aims of the organisation which were to ensure that people were well cared for and encouraged to be as independent as possible. The quality of the care provided was monitored by the company director and the registered manager.

We spoke with a visiting relative of the other person who lived at the premises. They said, 'My relative has extreme challenging behaviour and special needs. The staff here are the only people able to handle the whole situation."

The families of people using the service were very involved in their care and support and were able to express their views. The relative who we spoke with told us that they visited two or three times a week, and they were involved in reviews and support plans for the person where they could express their views.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw risk assessments and behaviour management plans that included the triggers for behaviours and how the staff should respond. A behaviour consultant provided guidance for each person on behaviour management and training for the support workers.

Each person had their own team of support workers, and the support that they received varied from one to one to three support staff to one person. This ensured that they were always supported by people that they knew and who knew and understood their needs and behaviours.