Juniper Court Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The management team listened to concerns about safety and investigated incidents and events, which were reported. Incidents, accidents and concerns were shared during handovers and daily meetings to ensure lessons were learnt and improvements made when needed. People, relatives and staff felt they could raise concerns with the management team.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People's needs were assessed before they moved to the service and in line with recognised best practice. Before a person moved to the home, a comprehensive assessment of their care and support needs was completed. This involved the person, relatives and health and social care professionals. This was to ensure people’s needs could be met safely and effectively. From the assessment, staff implemented a comprehensive care plan.

Feedback from health and social care professionals was positive. A professional confirmed the management team had been to a person’s previous care home to meet with them as part of the assessment process. This ensured the move to Warmley House was positive as staff understood the person and their support needs because they had current information to guide them.

Information was shared when people moved from one service to another or went into hospital. This included prescribed medicines and Recommended Summary Plans for Emergency Care and Treatment, which included decisions people had made about their end-of-life preferences.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Systems were used to record safeguarding concerns. This included information about the incident, what actions had been taken to minimise further risk and who this had been reported to. The management team notified the Care Quality Commission about incidents of abuse and described what action had been taken to keep people safe. This included reviewing the environment, people’s plans of care, seeking advice from health and social care professionals and requesting additional staffing to support.

Staff received training relating to keeping people safe and knew what they had to do where an allegation of abuse was raised. Staff told us the management team were responsive where concerns had been raised. A member of staff told us, “I would record what a person told me and then take this to the manager for them to complete an investigation.” Another member of staff told us, “I have no concerns about the care and support for people but if I did I would have no hesitation to go to the manager or the provider.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff knew people and the risks they faced well. The management team had a good oversight of risks and the actions being taken to reduce these. There was a whole home approach to managing risk with daily meetings to discuss areas of concern or changes. This was attended by heads of departments.

Care plans were detailed and guided staff on how to provide safe care to people. These identified people’s specific needs, for example, in relation to their mobility, skin integrity, and nutrition and hydration, and how these should be managed. This meant staff were able to support people safely.

Food and fluid charts were completed to monitor people’s intake where people were at risk of dehydration or weight loss. Whilst it was evident people were receiving sufficient fluids, the daily totals at the end of the day were not being calculated. This meant that if a person had not had sufficient fluids then action could be taken to address this. We reviewed this on the second day and found improvements had been made with running totals being completed.

One person’s care plan lacked guidance on what staff should monitor in respect of their mental health and epilepsy. We raised this at the time of the assessment. During the assessment the manager made contact with health professionals to find out more information, as this was not clear from information that had been shared with them at the initial assessment. This person had not come to harm, but staff would benefit from further information being sought to enable them to monitor the person’s health and wellbeing, and to mitigate any risks to the person in the event of a relapse in their mental health.

Staff described how they kept people safe without restricting them and supported them to have control over their life. For example, one person was being supported to access the community independently using a tracker to keep them safe. The person, their family and the social worker had been involved. This promoted positive risk taking, encouraging the person to have control and maintain their independence. However, another person was accessing the community independently and no risk assessment had been completed. The management team addressed this promptly.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Since the new provider took over the service they had completed some refurbishment to the home. This included redecorating, replacing the roof, replacing a lift and general ongoing maintenance.

Systems were in place to ensure the home was safe. This included checks on equipment, fire and gas appliances. There was a maintenance person that solely worked in the home. This ensured repairs were completed quickly and safely.We saw there was a broken shower in one of the bathrooms. This repair was completed promptly. Some toilet paper holders were difficult to reach. The maintenance person was reviewing all toilets and bathrooms to ensure these were accessible. This was because there was a risk that a person may twist and fall.

There had been a recent visit by the Fire Service, the provider demonstrated they had completed their recommendations and were waiting for them to return and sign off the work completed. Fire drills were not being carried out regularly involving staff. The management team were aware, and an action plan was in place to address the shortfalls.

The home had been recently inspected by the Food Standards Agency and had received a 5-star rating. This was the highest that an establishment could receive.

The design, layout and decoration of the home met people's needs. The home was divided into 4 units each having a lounge, dining area and a small kitchenette. There was a cinema and a hairdressing salon. People had access to secure gardens and open space.

The provider had ensured the service was 'dementia friendly'. For example, there were pictures outside people's bedrooms to help them find their room and signs on bathrooms to indicate their purpose. Corridors had been decorated with artwork and objects of interest. Bedroom doors in the dementia unit resembled front doors and were different colours. This helped people to find their way around the home as these acted as landmarks and aided communication.

CCTV cameras were in use in communal areas of the home. This was clearly communicated to people, staff and their relatives. This enabled the management team to monitor people’s care and assisted in keeping people safe. The home was secure, and key codes were used to protect those people at risk of leaving the building. This was clearly recorded in people’s Deprivation of Liberty Safeguards.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider used safe recruitment processes. There were sufficient staff ensuring people received the care and support they needed. Staff confirmed there were enough staff working to support people. Comments included, “Staffing levels are good but there can be peak times when it is busy, but I can always rely on my manager who helps me in those situations”, and “The staffing levels are generally good, but like many care settings, there can be busy times when it feels stretched”. They also said that the team pulled together to ensure people received the care they needed.

The registered manager completed a dependency tool to ensure suitable numbers of staff were employed. Additional staff were available for health appointments or to provide increased support to a person where they were at high risk of falls or risk to themselves or others.

People were supported by staff who had an induction that included shadowing more experienced staff, ongoing training and formal competency checks. Staff new to care completed the care certificate (a framework of 16 standards ensuring all support workers have the same introductory skills, knowledge, and behaviours to provide safe, compassionate, and high-quality care) as part of their 12-week induction.

There was a training programme, which was monitored by the registered manager. All staff had to complete refresher training at regular intervals. Examples included safeguarding, equality and diversity, health and safety, first aid, safe medicines administration, food hygiene, moving and handling, deprivation of liberty safeguards and mental capacity. Staff had completed training in supporting people with dementia and mental health. Whilst there was no one in the home with a learning disability or autism, the staff had completed training on autism awareness.

Specific training was available for nurses to enable them to keep up to date with their registration with the Nursing Midwifery Council and build on their clinical skills. Checks were completed to ensure nurses were registered and fit to practice.

Training was a combination of face to face and eLearning. The registered manager was a train the trainer in moving and handling and safeguarding. The provider had arranged further train the trainer courses for the nurses and seniors.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff worked together to keep the service clean and tidy. There was a designated housekeeping team, who followed a cleaning schedule to ensure the home was clean and clutter free. Whilst the home was clean, not all bathroom and toilet cleaning schedules were being signed, in line with the provider’s procedures. However, during the assessment these areas were visibly clean and free from clutter. A relative told us they had raised concerns about the cleanliness of their family members bedroom. Action had been taken to address this with further training being given to staff with improvements noted.

On day one of our assessment, we noted that some of the bathrooms did not have bins with pedal action lids. This was immediately addressed with new bins available by the end of the day.

Staff were observed to be wearing personal protective equipment (PPE) as appropriate, and regular checks by management were undertaken to ensure equipment was used safely. Staff had received training and were up to date with current guidance including what to do at times of an infection outbreak.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

People took medicines in line with their wishes. People’s preferences were clearly recorded.Medicine administration records (MARs) were completed accurately. The management team completed regular audits and took immediate action if errors were identified.

Protocols were available for people who had been prescribed ‘as and when’ medicines. There was a lack of detail for medicines to treat constipation, ensuring a person-centred approach in respect of timescales and linking to people’s bowel management charts.

Records for the application of topical creams were not being consistently completed. We raised this with the deputy manager who advised this was a recording issue which would be discussed with staff.

Staff had received appropriate training to ensure they gave medicines safely, and had their competency checked frequently.