Jemini Response Limited - 17 Jerome Close

Jemini Response Limited at 17 Jerome Close, Eastbourne, is a residential home providing personal care for up to three people. At the time of the inspection there were three people living at the service. People living at 17 Jerome Close were younger adults with learning disabilities, who had lived there since they were teenagers.

17 Jerome Close is a house in a residential area and had two floors. Bedrooms were on both floors and on the ground floor there was also communal living areas and an office. The home had a rear garden with a large, heated, outhouse that was used by staff and people.

The service has been developed and designed in line 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The outcomes for people using the service reflected the principles of Registering the Right Support by promoting choice, control, independence and inclusion. People’s support focussed on them having opportunities to maintain relationships, engage in activities of their choice and maintain their independence.

People were not able to tell us they felt safe however we observed staff interacting with people and spoke to staff about their understanding of safety issues, for example safeguarding. Relatives and professionals told us that they felt the service was safe. Staff knew people well and knew their care and support needs. Risk assessments were in place, specific to people’s needs. Staff were recruited safely and there were enough staff working each shift to meet people’s needs. There was a comprehensive induction process. Medicines were ordered, stored, provided and disposed of safely.

People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way and in their best interests. Staff had received training that was relevant to help them support people. This included mental capacity, challenging behaviour and safeguarding. People’s nutritional needs were met and people were offered choice. People received support from health and social care professionals.

Staff were attentive to people’s needs and were caring. People’s privacy, dignity and independence were respected and promoted. People’s differences under the Equalities Act 2000 were considered and respected.

Support received was person-centred and focussed on individual needs. Care plans were regularly reviewed with people, relatives, staff and professionals. People had routines which were important to them and a range of activities both inside and outside the home were provided. Strong links with the local community had been established. A robust complaints process was in place.

The registered manager was well thought of and staff, relatives and professionals told us they thought the home was well led. People reacted in a positive way with the registered manager who was a visible presence throughout the home. Audit processes were in place and were overseen by the registered manager. Feedback was sought from people, staff, relatives and professionals. Regular staff meetings were held.

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 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. The home used some physical restraint only.

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

Rating at last inspectionThe last rating for this service was requires improvement with one breach of regulation. (Published December 2018). 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 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.

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 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 and autism using the service can live as ordinary a life as any citizen.

This comprehensive inspection took place on 16 October 2018 and was announced. The service had 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.

At our last inspection we rated the service good. At this inspection we identified a breach of regulations so the overall rating is now requires improvement. Although the care provided was good, the records that demonstrated the running of the service were not up to date or accurate. The provider had recently identified that the systems for monitoring the service were not effective and had started to put in place better systems to monitor the service. We were given assurances following the inspection that these would be tightened up further. However, as care planning and record keeping had not been up to date or accurate, time was needed to fully implement these changes and embed them into everyday practice.

There were enough staff who had been appropriately recruited, to meet people’s needs. Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. Staff understood what they needed to do to protect people from the risk of abuse. Incidents and accidents were well managed. People’s medicines were managed safely.

People’s needs were effectively met because staff attended regular training to update their knowledge and skills. Care staff attended regular supervision meetings and told us they were very well supported by the management of the home. People were encouraged to make decisions and choices. They were supported to have maximum 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.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with them. People were supported to attend health appointments, such as the GP or dentist. Professionals spoke positively about the service. One health care professional told us, “Staff appear caring and seem to be able to manage clients and their complexities well and with compassion.” People had enough to eat and drink and menus were varied and well balanced.

Staff had a very good understanding of people as individuals, their needs and interests. People were supported to take part in activities to meet their individual needs and wishes. This included trips to the local parks, theatres, cafes and restaurants.

The environment was clean and well maintained. The provider had ensured safety checks had been carried out and all equipment had been serviced. Fire safety checks were all up to date.

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

There is a registered manager at the home who was also the registered manager for another home owned by the provider in the same Close. 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 told the registered manager two days before our visit that we would be coming. We did this because they were sometimes out of the home supporting people who use the service. We needed to be sure that they would be available in. The inspection took place on 10 and 11 October 2016.

There was an open, transparent and inclusive atmosphere at the home. Staff worked hard to ensure people received a service that promoted their independence, maintained their individuality and developed their well-being. The philosophy of the home was to ensure people ‘felt good’ about themselves. The registered manager had gone beyond what was expected of him as a registered manager to protect people and ensure they maintained a good quality of life.

The registered manager had a good oversight of the home. He worked with staff to promote continual learning and development to improve people’s lives. Staff were aware of their responsibilities and told us they felt well supported by the registered manager and their colleagues.

People were treated with kindness and positive, caring relationships had been developed. Staff knew the needs of people and treated them with dignity and respect. People exercised choice in day to day activities. Staff worked with people to help them reach their goals and achievements and supported them to maintain and improve their independence.

Systems were in place to involve people in making decisions about their care and treatment and people were supported to use these. Staff had a good understanding of people as individuals, their needs, likes and dislikes. Staff were able to communicate effectively with people using their preferred method.

People’s medicines were safely managed and they were supported to receive the medicines they had been prescribed in a way that met their individual needs.

Risks were well managed in ways that enabled people to make their own choices and to remain independent as possible. People were happy and at ease in the presence of staff. Staff were aware of their responsibilities in relation to protecting people from harm and abuse.

There were sufficient numbers of suitably trained staff to keep people safe and meet each person’s individual needs and preferences. Recruitment records showed staff employed were suitable to work at the home. There was a training and supervision programme in place to ensure staff maintained and developed their knowledge and skills.

Staff were able to recognise different types of abuse and told us what actions they would take if they believed someone was at risk. The registered manager and staff had a good understanding of mental capacity assessments (MCA) and Deprivation of Liberty Safeguards (DoLS).

People played an active role in planning, preparing and cooking the main meals at the home. They were supported to eat balanced diets that promoted good health.

People had access to external healthcare professionals when required. They received regular health checks from the dentist, optician and chiropodist.

We spoke with three staff and the manager about the delivery of care to people in the house and how this was monitored. Staff told us about how they engaged with the people they supported, the training they received, and opportunities for expressing their views.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We examined three staff files and found that robust recruitment systems were in place and appropriate checks were undertaken before staff began work.

We looked at the arrangements for the supply, storage, administration and safe disposal of medication and found that there were robust systems in place to ensure people's safety.

We looked at care documentation and monitoring information to support staff feedback and saw that monitoring information was used to inform actions plans and drive improvement.

We spoke with three staff and the manager about the delivery of care to people living in the house, and how this was monitored. We found staff spoken with demonstrated awareness and understanding of the needs of the people they supported and this was reflected in documentation seen. They were provided with appropriate training to ensure they had the skills necessary to support people with challenging behaviour at home or in the community. This ensured they were able to provide the right interventions when necessary, to maintain the safety of the person and others. We looked at care documentation and monitoring information to support staff feedback. We saw that monitoring arrangements and findings from this was used to develop an action plan of improvements.

We viewed the premises and saw that previous structural works had been completed. Each person in the house had a good sized bedroom that was personalised to their specific taste. There was evidence of ongoing investment in the house to maintain and improve it. Fire safety arrangements to meet Fire regulations were underway and also remedial works to the kitchen floor.