1-3 Emily Jackson Close

1–3 Emily Jackson Close is a care home providing personal care to up to 18 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 17 people using the service. The service is set across 3 individual bungalows.

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

Right Support:

Staff provided effective support to identify people's aspirations and goals and assisted people to plan how these would be met. Staff focused on people's strengths and promoted people’s independence. There was a consistent approach to supporting people to learn new daily living skills. Staff enabled people to access health and social care support in the community.

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.

Right Care:

Staff understood the risks to people's health, safety and welfare. Risk assessments provided guidance for staff about individual risks. However, some risk assessments did not have enough guidance for staff to ensure people were as safe as possible. Whilst staff knew people well, positive behavioural support plans were still in the process of being reviewed and updated. Without robust plans and information there was a risk people were not supported in a consistent way.

People were protected from the risks of harm, abuse and discrimination because staff knew what action to take if they identified concerns. Accidents, incidents and near misses were recorded and reviewed. However, the level of detail recorded varied and there was a risk of action not being taken in a timely way.

There were enough staff to provide the support people needed.

Staff provided care to people which was person-centred and promoted people's dignity, privacy and human rights. People's individual choices were recognised and respected. Staff promoted equality and diversity in their support for people and their protected characteristics were considered.

People could communicate with staff as staff understood their individual methods of communication. People were empowered to take part in activities of their choice. People were supported to keep in touch with people who were important to them. Relatives spoke positively about the support their loved ones received.

Right Culture:

Checks and audits were being regularly completed. Shortfalls were identified and action taken to address these. However, we found some shortfalls around risk assessments and accidents and incidents which had not been identified. We discussed this with the manager who agreed to take action to remedy these.

The service enabled people and those important to them to work with staff to develop the service.

Feedback was requested from people, relatives and health care professionals.

Safe recruitment practices were followed. Staff knew and understood people well. The provider and staff worked hard to develop strong leadership. The management structure had been changed following the last inspection and staff spoke about the positive impact this had had.

Quality monitoring systems were being developed and embedded. Morale within the staff team was good and staff felt valued.

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 inadequate (published 23 October 2023). 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. We found the provider remained in breach of regulation 17 (good governance).

This service has been in Special Measures since 23 October 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 1-3 Emily Jackson Close on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to good governance 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 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.

1-3 Emily Jackson Close is a care home providing personal care to up to 18 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 18 people using the service. The service is set across 3 individual bungalows and 6 people live in each bungalow.

People’s experience of using this 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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. For example, one person did not have any documentation regarding a restriction detailed in their care plan. People’s care plans did not always contain information about how staff can support them to achieve their goals and aspirations. The service gave people care in an environment that was not safe or clean. For example, one person had mould on the shower trolley (A shower trolley is a convenient and secure facility allowing the service user to safely shower in a comfortable lying position) and cleaning chemicals were easily accessible and not locked away. People were supported to visit the home before they moved in. Although this took place staff felt people had not been properly consulted. One person also told us they hadn’t been informed a new person had moved in.

Right Care

Not all staff understood how to protect people from poor care and abuse. For example, staff had not recorded or reported potential safeguarding incidents to the local safeguarding team. People’s care and support plans did not consistently reflect their current needs. For example, one person’s support plan had not been updated when their eating and drinking needs changed, their care plan was last updated in 2021. We observed staff to not always being caring. For example, one staff member referred to the effects of a person’s Parkinson’s condition as them doing this for attention. This showed a lack of consideration and empathy for the impact Parkinson's had on the person.

Right Culture

People did not always lead empowered lives. People did not consistently receive good quality care and support. For example, staff had not always received training in areas needed to support people with all their health needs. There had been inconsistent management at the service and a lack of role models for staff. Relatives told us 'It's very hard to speak with staff as they are always busy.' Whilst we received some negative feedback, relatives also gave some positive feedback about the care provided, for example, ‘Cannot fault the care, he has never been surrounded by so much love and care.’ The provider had processes in place to gather relative’s feedback, however we received mixed reviews as to whether this was effective. One person told us, “They used to do fortnightly calls but realistically I can't expect that now." However, other relatives told us they were happy with the process to give feedback.”

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 good (published 01 December 2017)

Why we inspected

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

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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘1-3 Emily Jackson Close’ on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, managing environmental and health risks, person centred care, dignity and respect, consent, staffing and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection on 4th April 2017, the service was rated as Good. At this inspection, we found the service remained Good.

There was no registered manager in post. At the time of our inspection, an acting manager in post was going through the processes with the Care Quality Commission (CQC) 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.

The provider had systems in place to protect people against abuse and harm. The registered provider had effective policies and procedures that gave staff guidance on how to report abuse. Staff demonstrated good knowledge of the safeguarding policy and procedures.

Risks to people's safety had been assessed and actions taken to protect people from the risk of harm. Risk assessments were personalised to people's needs and reviewed on a regular basis and when required.

Staff recruitment practices ensured that staff were safe to work with vulnerable adults. There were enough staff on duty to provide safe personalised care. Trained competent staff managed medicines safely. There were regular audits carried out by trained staff to identify any areas for improvement and to ensure there were sufficient levels of stock.

The principles of the Mental Capacity Act 2005 (MCA) were adhered to for more complex decisions. People's mental capacity was being assessed appropriately and meetings took place to make decisions on people's behalf and in their best interests, when they were unable to do so. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options were considered as per the MCA.

People were assisted with their nutrition and hydration needs. The acting manager involved a dietician to give guidance to staff on appropriate diets and methods. People who were at risk of pressure sores had appropriate assessments in place that identified methods to mitigate risk.

People living at the service had access to a wide range of activities that were tailored to their needs. People would go on regular outings with staff to places they enjoyed going. People told us they were very satisfied with the care staff and the support they provided. Relatives told us they were happy with the service their loved ones received. People and their relatives told us they were involved in the planning of their care. Care plans were being reviewed on a monthly basis by staff. Staff respected people's privacy and dignity at all the times. The provider had ensured that people's personal information was stored securely and access only given to those that needed it.

The acting manager was approachable and took an active role in the day to day running of the service. Staff felt confident to approach the acting manager with any concerns they may have. The acting manager encouraged relatives and staff to voice their opinions of the service through regular meetings and surveys. The acting manager used effective auditing systems to identify any areas of improvement within the service. The provider had ensured that there were effective processes in place to fully investigate any complaints. Outcomes of the investigations were communicated to relevant people.

1-3 Emily Jackson Close provides accommodation with personal care and support to 18 people with learning disabilities and physical disabilities. The accommodation is split into three bungalows with up to six people living in each one. Each bungalow is self-sufficient with its own kitchen, dining room, lounges and garden

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There was a registered manager in post. 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.

The provider had ensured there were sufficient numbers of staff available for people living at the service to pursue activities. Additional staff were allocated on days that trips away from the service were organised.

The provider had systems in place to protect people against the potential risk of abuse and harm. The registered provider had effective policies and procedures that gave staff guidance on how to report abuse.

Risks to people's safety had been assessed and actions taken to protect people from the risk of harm

Medicines were managed safely and people had access to their medicines when they needed them.

There was sufficient numbers of staff to provide care to people throughout the day and night. When staff were recruited, they were subject to checks to ensure they were safe to work in the care sector.

The provider had ensured that people lived in a safe environment by ensuring effective auditing systems were in place to identify when safety certificates were to be reviewed and by providing appropriate environmental risk assessments.