Archived: James House

We found the following examples of good practice.

• Visitor information was clearly displayed at all the entrances to the home. Visits to the home were arranged by appointment and visitors agreed to follow the safe infection control guidelines provided.

• The provider had guidelines for people who had tested positive for COVID 19 with or without symptoms and those returning from any hospital visits were supported by staff self- isolate for a 14- day period.

• The registered manager understood the need to support people’s and staff wellbeing. They recognised signs when people’s mental health was deteriorating and worked closely with health and social care professionals to find a speedy and safe solution.

•The registered manager and staff used, “dementia friendly,” language to support people to understand the pandemic and the reasons for the extra PPE use.

Further information is in the detailed findings below.

James House is a care home that provides accommodation and personal care for up to 12 people. At the time of the inspection 9 people were using this service. This care home is owned by the Abbeyfield Society who have a number of other care services in the UK.

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

At this inspection we found the provider had made improvements in the areas of concern we found at the last inspection. The provider had addressed the environmental hazards identified at the last inspection and now stored equipment in an appropriate manner. However, we found some aspects of the service now required improvement.

Staffing need was not being assessed and people complained to us of not receiving a timely service from staff on occasions. Whilst people spoke positively about the care workers they all felt there was a lack of staff that sometimes impacted on the service they received.

One person’s documents had not been updated in a timely manner this had included assessments used to monitor their health and well-being.

Although not effective in addressing the concerns identified above the registered manager had systems in place to monitor and manage the quality of the service provided.

Medicines records were completed without error or gaps and medicines were stored in a safe manner.

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.

The provider notified the local authority if they identified a safeguarding adults concern. The registered manager demonstrated lessons learnt had been shared with senior staff working with the provider, so they could learn from each other’s experiences.

Staff had received an induction prior to commencing their role and ongoing training to support them to work in a well-informed way with people. Supervision was provided to support staff to undertake their role.

People told us they were given a choice of meals and that food provided was good. Care workers were reminded by the provider to ensure people remained well hydrated.

Staff were described as caring and people told us staff provided care as they wanted it to be provided. People were supported to make day to day decisions.

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 requires improvement 11 October 2018 (published on 4 December 2018). At this inspection there a breach of regulation 15 in Premises and equipment. The provider completed an action plan after the last inspection to show what they would do by November 2018 to address the concerns identified.

At this inspection we found an improvement had been made in this area and the provider was no longer in breach of Regulation 15. However, at this inspection we found a breach of Regulation 18 Staffing. And Regulation 17 Good governance. This service has been rated requires improvement in safe and well-led and good in effective, caring and responsive. The rating is requires improvement overall.

Please see the action we have told the provider to take at the end of this report.

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.

At our last inspection in February 2016 we rated the service good in all the key questions and therefore good overall.

James House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

James House is part of the Abbeyfield Society. This is a charitable organisation that provides care and accommodation to older people living in England. James House provides accommodation and personal care for up to 12 older people or younger adults above the age of 55 years. At the time of our inspection 11 people were living at the home.

There was not a registered manager in post as the previous registered manager had left in August 2018. 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. There was a manager appointed in August 2018 who was in the process of registering with the CQC.

We found during our inspection that the bathroom was used to store equipment. This had meant it could only be used if items were removed first. The provider had plans to refurbish and modernise the facilities but this had not taken place at the time of our inspection. In addition, at least one window on the first floor did not have a window restrictor. This increased the risk of people falling from height.

Staff told us they felt well supported by the manager who had an open-door policy and was available to speak with. Staff had received training but some staff had not received all their refresher training. This concern had been identified by the manager who was in the process of addressing the short falls. We found despite some areas of training being overdue staff spoke clearly about key areas such as safeguarding and the Mental Capacity Act 2005 (MCA) and told us about the training they had received and how they implemented it in their work.

People told us staff were kind and caring and all said how much they liked their bedrooms and the home. We observed that staff were respectful and promoted people’s self-respect by supporting them to remain as independent as possible.

People’s care needs were assessed prior to them being offered a placement to ensure appropriate care could be provided. People had signed to give their consent to care as it was stated in their care plans. Care plans were reviewed and updated on a regular basis and in response to changing circumstances.

Risks were identified through the assessment process and measures were taken to mitigate the risk of harm and guidance for staff was provided.

There were systems in place for the safe storage and administration of medicines.

People told us the food was, “very good” and “lovely.” The cook tried to make sure people had the meals they wanted and usually produced homemade meals. The staff were aware of the need for people to remain hydrated and ensured people drank enough throughout the day. People’s well -being was promoted and any sign of ill health was flagged with the appropriate health professional in a timely manner.

The manager had systems in place to recognise and report all safeguarding adult concerns. They responded well to complaints and addressed concerns. They were working in line with the MCA and Deprivation of Liberty Safeguards (DoLS) to uphold people’s rights.

Audits and checks were carried out by the senior staff, manager and provider. There were good lines of communication in the home that included, daily shift handovers, informal information sharing and bimonthly staff meetings. The manager talked with people living in the home daily and held regular meetings to keep them informed of changes and listen to their views.

The manager told us they felt well supported by the provider and had the opportunity to network with other services.

We found one breach of the regulations in relation to the premises and equipment. You can see what action we told the provider to take at the back of the full version of the report.

James House is a residential home and is part of The Abbeyfield Society. It provides accommodation for up to 12 older people in single rooms. The home is situated within a residential area of the London Borough of Hillingdon. At the time of our visit there were 10 people using the service but two of them were in hospital.

We previously inspected James House on 29 April 2014 and the provider had met all the regulations that were inspected.

At the time of the inspection there was a registered manager in place. 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.

People told us they felt safe when they received support and the provider had policies and procedures in place to deal with any concerns that were raised about the care provided.

The provider had processes in place for the recording and investigation of incidents and accidents. A range of risk assessments were in place in the support folders in relation to the care being provided.

The provider had an effective recruitment process in place. There was a policy and procedure in place for the administration of medicines.

The provider had policies, procedures and training in relation to the Mental Capacity Act 2005 and care workers were aware of the importance of supporting people to make choices.

Care workers had received training identified by the provider as mandatory to ensure they were providing appropriate and effective care for people using the service. Also care workers had regular supervision with their manager and received an annual appraisal.

People we spoke with felt the care workers were caring and treated them with dignity and respect while providing care. Care plans identified the person’s cultural and religious needs.

A range of activities were arranged at the home and people told us they enjoyed them.

Detailed assessments of the person’s needs were carried out before they moved into the home and each person had a care plan in place which described their support needs. Care workers completed a daily record of the care provided.

The provider had systems in place to monitor the quality of the care provided and these provided appropriate information to identify issues with the quality of the service.

The inspection was carried out by a single inspector during one day. The focus of the inspection was to answer five key questions;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary

please read the full report.

Is the service safe?

People told us they felt safe and well cared for.

The medicines prescribed to people using the service were stored in a secure and appropriate manner. We saw the medication administration record (MAR) charts for all the people using the service which were up to date. Medicines were safely administered and during our inspection we observed the staff member administering medicines to people using the service. We saw that they ensured the person had water if required and they waited to see them take the tablets before recording it on the MAR chart.

Systems were in place to ensure staff reported any incidents or accidents and the manager reviewed and investigated any issues. The home had processes in place for the manager and staff to learn from events such as accidents and incidents, complaints, concerns and whistleblowing.

There were arrangements in place to deal with foreseeable emergencies. We saw that fire safety assessments had been carried out for all the people using the service. An evacuation plan had been recorded for people who had a visual impairment or mobility need. We saw that these assessments were up to date.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). At the time of the inspection there were no DoLS in place at the home.

Is the service effective?

Individual's health and care needs were assessed and they and/or their relatives were involved in the development of the care plans. The care plans identified specific support needs including mobility and personal care. The care plans and risk assessments were regularly reviewed and were up to date to ensure people received appropriate care and support.

Is the service caring?

We saw staff treated people with dignity and respect. People we spoke with said they felt safe and they liked the staff. One person said "The staff are wonderful and really nice".

People's preferences, interests and diverse needs had been recorded in their care plans. Support was being provided in accordance with people's wishes.

Is the service responsive?

During our inspection we saw a copy of the complaints procedure leaflet with large print in the dining room. Information was also displayed on a notice board on the ground floor. People also had access to copies of the complaints policy in their bedrooms. The manager showed us a copy of this which had been translated into braille. The manager told us the complaints procedure was discussed at the regular resident's meetings. This ensured that people using the service or their family could check the procedure if they wished to make a complaint. One person we spoke with said "I do not need to know how to complain as I am really happy here".

Is the service well led?

There were regular audits of the care plans and risk assessments carried out by the carers and manager. Any actions identified were recorded on a check list and staff confirmed when they had been completed.

The service had a quality assurance system in place. We saw records that showed us that any identified issues were addressed promptly. As a result there was ongoing improvement in the quality of the service.

We found that people had been involved in decisions relating to their care and care plans had been developed to meet people's needs.

People were protected from abuse. Both staff and people using the service knew the procedure for reporting any concerns they might have.

The service had thorough recruitment processes in place to make sure that all required pre-employment checks were carried out. This meant that people using the service were cared for by suitably qualified staff.

The provider had an effective system to regularly assess and monitor the quality of the service that people received. People's concerns had been listened to and acted on and their wishes taken into consideration.