Jigsaw Creative Care Limited - 77 Russell Street

Jigsaw Creative Care Limited - 77 Russell Street is a respite care service. It can provide accommodation and personal care for up to 3 people at any one time. 10 people used the service at different times. On the day of the inspection 2 people were using the respite service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Systems in the service supported this practice.

People were put at increased risk of fire. During the inspection we found risks relating to fire safety had not been adequately mitigated. People using the service did not have access to the garden, however, actions were taken by the management team after the inspection to ensure people had access to the garden. There was no cleaning schedule for the entire property and protocols were not in place for cleaning bedrooms in between respite stays.

Care plans were individualised and contained a comprehensive assessment of people’s needs and abilities.

Right Care:

Medicine administration records were not always fully completed.

Safeguarding policies and procedures were in place, and staff knew how to report any concerns. Staff received training in safeguarding adults and children.

Right Support:

People were supported by staff who knew them well. Relatives told us and we observed, staff respected people and treated them with dignity and compassion. People were supported to maintain their privacy and promoted their independence. The service had training appropriate to staff roles, this included training in learning disabilities and autism and positive behaviour support.

People were supported to access the community; partake in activities they enjoyed and socialise with peers. Staff at the service knew how to communicate with people effectively to ensure people’s views were heard and respected.

Right Culture:

Systems and processes did not always effectively ensure good oversight of the service. Audits had not always identified the areas that required improving found on inspection.

Complaints procedures were in place. Staff and relatives told us they knew how to complain, however there had been no complaints raised.

The management team were open and transparent throughout the inspection process. Feedback from relatives was positive.

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 in all domains. At this inspection we found the rating for the domains of safe and well led was requires improvement with the overall rating for the service now being requirements improvement.

Why we inspected

The inspection was prompted by the length of time since we had last inspected. We undertook a focused inspection to review the key questions of safe and well-led only. During the inspection we found concerns relating to premises and documentation within people’s care files, so we widened the scope of the inspection to include effective, caring and responsive.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, and good governance. We have made a recommendation in relation to recruitment. 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection the service was rated requires improvement in safe and good in effective, caring, responsive and well-led. The overall rating for the service was good. At this inspection we found the service had made improvements in keeping people safe. The service remained good in all the other domains and therefore the overall rating remains good.

People received safe care from the service. Improvements had been made to maintain the property and garden to a good standard and reduce risks to people’s safety. Robust recruitment procedures were now followed to ensure as far as possible only suitable staff were employed. Risk assessments were completed to enable people to receive care with a minimum of risk to themselves or the care staff. Staff were trained to safeguard and protect people. They understood their responsibility to report concerns.

People continued to receive effective care from staff who had been trained and had the necessary skills to meet people’s needs effectively. Staff were supported through one to one supervisory meetings, annual appraisals and staff meetings. They were able to seek advice when necessary and had opportunities to discuss and review their work. People were supported to have sufficient to eat and drink. When necessary their nutritional needs were monitored and professional advice was sought appropriately. People’s healthcare needs were mostly managed by their families. However, when required staff supported people to attend appointments and/or seek advice.

People 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. However, we noted these were not recorded in accordance with the Mental Capacity Act (2005) MCA and have made the following recommendation. We recommend that the provider refers to current guidance on recording best interest meetings and decisions in line with the MCA.

The service remained caring. We observed staff were kind and patient when supporting people. People’s privacy and dignity was protected and they were treated with respect. People and their families were involved in making decisions about their care. Staff enabled people to maintain and develop independence as much as they were able to.

The service remained responsive to people’s individual needs. Staff knew people very well and care plans were focused on each individual, their preferences, routines and choices. People had access to varied activities which they enjoyed and engaged in. Activities were designed to suit people’s particular needs and interests. Complaints were investigated and resolved in line with the provider’s policy.

The service continued to be well-led. The registered manager promoted an open, friendly and person centred culture. They led by example, were supportive of the staff team and listened to feedback and views to make improvements. The quality of the service was monitored and regular audits and checks were completed.

Further information is in the detailed findings below.

The manager was not present during our inspection. We toured the home and grounds, and spoke with staff regarding work recently completed at the home. Staff we spoke with told us that the maintenance issues had been resolved quickly after our inspection. We viewed all of the rooms and observed the home had recently been decorated. Staff told us the decoration was a great improvement. Staff we spoke with told us the residents had told them they were happy with the decoration of their bedrooms. Maintenance issues raised at our last inspection had been addressed.

We viewed the garden and observed concerns that we had raised had been addressed and the garden had been well maintained. We noted that an additional hand rail had been installed along the path to the garden. This ensured people were able to access the garden safely.

At the time of the visit one person was present but left to take part in activities. Most people supported by Jigsaw were limited in their abilities to understand our questions and communicate verbally. We were able to speak later with relatives of people who stayed at the home. We spoke with the local authority and local commissioning team. Relatives we spoke with, the local authority and commissioning team had no concerns about the care and service provided by the home.

We looked at the safety and suitability of the home. On inspection it was evident that parts of the home required redecoration and maintenance. We observed one of the bedrooms had wall paper peeled off and was in need of decoration. We noted maintenance issues raised by staff at the beginning of the year had not been resolved at the time of the inspection.

We noted the home was clean and free from odours. We reviewed the policies for infection control and found these to be up to date and adhered to.

We viewed three recruitments files and found these to contain all the information required.

We viewed the records of the home including care plans, recruitment files, policies and procedures. We found these to be up to date, fit for purpose and securely stored.

Everyone we spoke to was complimentary about the service calling it 'absolutely excellent', 'top class' and 'second to none'. One relative told us "(person) seems really happy'.

We observed staff asking for people's consent and informing them about their care. One person told us 'they treat (person) with respect and keep (person) informed'.

We observed care being delivered in line with people's care plans. One relative told us 'I'm happy I've found a place that can deal with my son's needs'.

There were procedures in place to ensure staff administered medicines competently and safely. One relative told us 'I send in the meds and they give it to (person), no probs'.

Relatives told us they felt staff were 'friendly' and 'professional'. One relative told us 'I wish they'd go and train other people, they're very up on everything'. We observed staff interacting with people in a compassionate, competent manner.

There was a clear complaints procedure and we saw examples of staff responding to people's dissatisfaction and working to resolve the issue, where people were unable to verbally communicate this.