Jigsaw Homecare Ltd

Jigsaw Homecare is a domiciliary care agency providing personal care to older people, some of which were living with dementia. The service supported 99 people at the time of the inspection. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. There were 44 people receiving a regulated activity at the time of the inspection.

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

People’s lived experience of receiving support from Jigsaw Healthcare had improved since our last inspection. People’s individual risks had been assessed; however, staff were still not provided with guidance to support and manage them.

People’s records did not consistently contain all the information required to be able to support them in a personalised way, there was also a lack of recorded information around people’s capacity.

The registered manager had made improvements with the governance of the service by implementing audits and carrying out quality monitoring. Despite improvements made this continued to be an area of improvement and audits implemented needed to be embedded and sustained. People and staff felt more involved in the service and supported.

Medicines management had improved; however, we made a recommendation around guidance for staff on medicines administered when required. People were receiving their calls more consistently, both in terms of timings and lengths. People received care from staff who were trained to undertake their role, who felt supported and had been recruited safely.

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 did not always support this practice.

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 (4 April 2022). 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. However, the provider remained in breach of some regulations.

This service has been in Special Measures since 4 April 2022. 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

We undertook this focussed inspection to check whether the Warning Notices we previously served in relation to Regulation 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jigsaw Homecare Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk management and record keeping at this inspection.

We have made a recommendation in relation to medicine management.

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

Jigsaw Homecare is a domiciliary care agency providing personal care to older people, some of which were living with dementia. The service supported 124 people at the time of the inspection. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. There were 80 people receiving regulated activity at the time of the inspection.

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

People’s care was not planned in a way to ensure their needs and preferences were being met. People told us call times and lengths were inconsistent and they didn’t know which carer was coming or when. Risk management was poor and placed people at increased risk of harm or injury. People were supported with their medicines but management of this placed people at increased risk of not receiving their medicines as prescribed.

People were placed at increased risk because the provider and registered manager failed to implement effective quality monitoring systems and auditing processes. The registered manager did not effectively carry out their duties and responsibilities and had a lack of understanding of their statutory obligations.

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 (published 4 May 2021). 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 the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to staffing, safeguarding, call times and management. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this 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 Jigsaw Homecare Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing, safeguarding, risk management, medicines and how the service is managed 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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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.

Jigsaw Homecare is a domiciliary care agency providing personal care to older people, some of which live with dementia. The service currently supports 213 people. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. There were 90 people receiving regulated activity at the time of the inspection.

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

The provider's systems for assessing and monitoring the safety and quality of the services provided were not always effective in identifying shortfalls and improving the service. Quality control audits were not carried out effectively to improve the service in some areas.

Risks to people's health, safety and welfare had not been adequately assessed and mitigated. People’s medicines were not managed safely.

We were not assured that the provider was following guidance for good infection control practices.

The service was not consistently well-led. People were put at risk because the provider and registered manager failed to ensure suitable quality assurance checks were in place. The provider did not ensure staff always followed policies and procedures for the delivery of safe care.

The provider had not consistently notified CQC of significant events as they are legally required to do.

Staff worked in partnership with other health and social care professionals.

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 30 January 2018)

Why we inspected

We undertook this inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received related to staffing levels, training, missed calls, missing care plans in people’s homes and medicine administration records. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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 Jigsaw Homecare on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, management of medicines, staffing and 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

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

A registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Jigsaw Homecare Limited currently supports 46 people who receive some element of support with their personal care. This is the service’s second inspection under its current registration. At the last inspection on 23 June 2016 the service was rated Good overall. After this inspection the service maintained this rating.

People continued to receive safe care and processes were in place to reduce the risk of people experiencing avoidable harm. Safe staff recruitment processes were in place, although more robust checks of staff criminal records were needed. There were enough staff to meet people’s needs. Safe medicine management processes were in place and people received their prescribed medicines safely. Staff were aware of how to reduce the risk of the spread of infection and processes were in place to investigate accidents and incidents appropriately.

Staff were well trained and their performance was regularly monitored. People were treated equally and were not discriminated against as a result of their health needs. Where needed, people were supported to lead a balanced and healthy lifestyle. The registered manager had ensured effective relationships with external health and social care organisations were in place and people’s health was regularly monitored. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; there were policies and systems in the service support this practice. However clearer documentation was required to ensure all decisions made clearly evidenced that they were in each person’s best interest.

People felt staff were caring, treated them with respect and dignity and listened to what they had to say. Staff talked with people and made them feel valued. People were supported by staff who were respectful and empathetic. People were involved with making decisions about their care. People’s diverse needs were respected. People were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates.

People were supported to lead their lives in the way they wanted to. For some, this meant support to access their community and carry out their preferred hobbies and interests. People and their relatives were involved with agreeing the level of care and support people would receive when they started to use the service. Care records contained person centred guidance that enabled staff to respond to people’s individual preferences. People were treated equally, without discrimination and systems were in place to support people who had communication needs. People felt able to make a complaint and were confident it would be dealt with appropriately. The provider’s complaints process needed updating with the local ombudsman’s details.

People and staff felt valued and spoke positively about the registered manager. The majority of people spoken with would recommend this service. Staff were made aware of the provider’s aims and values and were held accountable for their actions. The service was managed well by a registered manager who was dedicated to improving people’s lives. The registered manager and the provider continually looked to improve the service provided and expanded their knowledge by attending locally run forums. Quality assurance processes were in place and these were effective.

Jigsaw Horizons Limited a domiciliary care service which provides personal care and support to people to enable them to live independently in their own home. At the time of inspection 37 people were receiving personal care from the service.

The service has 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.

People who used the service and those supporting them knew who to report any concerns to if they felt they or others had been the victim of abuse. Any risks to the health and safety of people and staff had been identified and detailed plans were in place to reduce these risks. Accidents and incidents were investigated. There were enough staff to attend all planned calls punctually and meet people’s needs. People received their medicines as prescribed, and staff provided people with as much or as little support they needed to ensure this.

People were supported by staff who had received the appropriate training to support them effectively. Staff received supervision of their work. People received the support they required from their staff to ensure they had sufficient to eat and drink. People were provided with the support they needed to enable them to have access to their GP and other health care professionals when they need them.

The Care Quality Commission (CQC) monitors the use of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff were aware of the principles of the MCA and how this might affect the care they provided to people. Where people had the capacity they were asked to provide their consent to the care being provided.

People were supported by staff who were caring and treated them with kindness, respect and dignity. People were involved in the planning and reviewing of their care to ensure that they received the care they wanted.

Care plans were written in a way that focused on people’s choices and preferences. A complaints procedure was in place and people felt comfortable to speak up if they were unhappy about any aspect of the service they received.

The culture of the service was open. People were supported by staff who were clear about what was expected of them and staff had confidence that they would get the support they needed from the registered manager. People and staff were asked for their opinions about the quality of the service. The registered manager undertook audits and observed practice to ensure that the care provided met people’s needs. There were strong links with other community resources to ensure that people got the best support possible.