James Court Residential Care Home

Our last inspection visit took place on 7 February 2017, and the overall rating for the service was ‘requires improvement.’ The key question ‘is the service well led?’ was rated as ‘inadequate.’ We found the provider was in breach of six Regulations, and we arranged a meeting with the provider and registered manager on 20 March 2017. They told us how they would ensure that the improvements needed would happen, and sent us an action plan on 16 May 2017, with the details of how they would do this. As one key question was rated as ‘inadequate,’ this meant we would visit the service to complete another inspection within six months of the report being published.

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.

At this inspection, we found that improvements had been made, but further were needed to ensure the service was consistently well led. This was because some people’s care records still had to be reviewed to ensure they were up to date. Certain relevant assessments still needed to be completed. The provider did not have a systematic approach to determine the levels of staffing that were required.

People continued to be safe living at the home. Staff understood how to protect people from harm and abuse. Risks to individuals were assessed, monitored and reviewed, and people were involved in these decisions when able. There were enough staff to meet people’s needs, and the provider followed safe recruitment practices. People’s medicines were managed safely, and they were protected from any harm associated with them.

When people were not able to make certain decisions for themselves, the provider followed the guidance available to ensure support was in their best interests. Staff gained people’s consent before they assisted them, and were aware of how to support people to make decisions. Staff received training to ensure they could carry out their roles effectively. People were supported to maintain a balanced diet and access healthcare services when needed.

People were supported by staff who had developed positive, caring relationships with them. People were listened to, and they were involved in making day to day decisions about their care. Their independence was promoted, and people were supported to have control in their lives. Staff understood how to ensure people’s privacy and dignity were respected.

People were able to participate in various activities they enjoyed, and were protected from the risk of social isolation. People were involved in the planning of their support, and received care that was individual to them. Their views were taken into account when improvements were made in the service and they knew how to raise concerns.

There were now systems in place to monitor and assess the quality of care people received. Actions were taken to make improvements and staff felt supported in their roles. The registered manager and provider showed a clearer understanding about their responsibilities as registered persons.

We will continue to review this service to ensure these improvements continue and are embedded and sustained in the future.

This inspection visit was unannounced and took place on 7 February 2017. At our last inspection visit in January 2016 we asked the provider to make improvements to areas relating to, staffing in areas of the home, peoples capacity and aspects of auditing to drive improvements. The provider was asked to compete an action plan to explain the actions they would take to make improvements, however they didn’t compete the plan. At this inspection, we found improvements had not been made. The service was registered to provide accommodation and personal care for up to 12 people. At the time of our inspection, there were 10 adults with learning disabilities living there.

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 service had not completed assessments to reflect people’s capacity relating to specific decisions. We could not be assured that when people lacked capacity their needs had been considered in line with the guidance available. . Peoples care plans had been reviewed, however the information was not easily accessible to ensure the person was receiving the correct level of care and support.

Staff had not received training to develop their knowledge and skill when supporting people with behaviours that challenged. Competency checks had not been completed to ensure training had been understood and was put into practice.

People had been allocated specific staffing hours to meet their needs. However we saw that these people did not receive this agreed level of support and the staffing hours had been combined to provide support to all the people living at the home.

The provider had not completed audits to support the development of improvements or to consider any trends in areas of concern. People’s views had been considered however they had not been correctly analysed or shared with people so they could see that their views had been considered.

We saw that the previous rating was displayed in the reception of the home as required, however in the incorrect format. The manager had not understood their responsibility of registration with us and we had not received all the notifications relating to incidents at the home.

People told us they felt safe and that staff knew how to recognise signs of abuse and what they needed do to protect people from abuse. Risks to individuals and the environment were identified and managed. People enjoyed the food and felt they had choices of the meals they received. Staff sought people’s consent before providing any care and support. People received their medicine in accordance with their needs and staff had a good understanding when additional medicine was required to maintain people’s health. Health care professionals were involved in people’s on-going health needs and the staff knew how to make referrals to access additional support then required. People were able to engage in social activities.

There was a registered manager at the service. 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.

Consent to care was not always sought in line with legislation and guidance. Some people did not have the capacity to make certain decisions, and it was not clear how best interest decisions had been made on their behalf. We saw some people may have had restrictions placed upon them as they were not able to go out on their own and may not have had the capacity to make decisions about their safety. Applications to ensure these restrictions were lawful had not been made.

We saw that there were sufficient staff numbers to keep people safe. However the way staff were deployed at certain times meant that they were not always available to meet people’s needs in a timely manner.

We found that improvements were needed in the way audits of the service were completed and how quality monitoring and actions required were analysed. A new system was in the process of being introduced. Staff supervisions needed to be completed, and consideration of how staff put any learning into practice was required. Consistency in the reporting of statutory notifications was also required.

People told us they felt safe living there and staff understood how to protect people from harm and abuse. Risks were identified and managed in a way that still enabled people to have choice and control in their lives. Medicines were administered safely and safe recruitment practices were in place.

People received care from staff who knew them well and understood how to support them in the best way. We saw that people were enabled to maintain a balanced diet and were encouraged to make choices about the meals they had. Staff were aware of any specialist diets and supported people to understand this. The staff ensured that people had access to different health care professionals when needed and knew how to look out for signs that people were unwell.

Positive caring relationships had been developed and we found that people were treated with respect and dignity. We saw that people were encouraged to make choices in their lives and express their views. The people who used the service were encouraged to be independent and enabled to have some control in their lives.

The service provided care that was individual to the people living there and they were supported to take part in various activities at home and in the community. The provider had responded to changes in people’s day time routines and had increased the staffing levels to reflect this.

There was a positive culture at the service, and staff felt supported by the registered manager. They told us they were approachable and responsive. We found that the registered manager was keen to make improvements within the service.

You can see what action we told the provider to take at the back of the full version of the report.

We found people using the service were safe because the staff were given clear instructions, support and guidance. People told us they were treated with care and compassion and the staff responded well to their needs or concerns. One person using the service said, 'I like the staff we spend good time together.' Another person told us, 'It's a good house and I'm happy and safe.'

We found people received appropriate nutrition. People told us they enjoyed the meals provided.

We looked at the cleanliness and suitability of the environment to ensure people lived in a home where the d'cor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

We saw the staff were offered the training they needed to support people using the service in the most appropriate way.

We spent time with people living in the home, and where people were unable to tell us about their experiences due to their learning disability, we spent time observing the support they received from the staff. We spoke with six people using the service and three members of staff.

We saw people received the care and support that met their individual needs. People had lived together for a number of years and one person told us, 'This is my home where I live with my friends. I'm very happy here.' Another person told us, 'The staff help us and I'm never bored here, there's always something for me to do.'

The staff interacted with people in a positive, sensitive, and respectful manner. The staff we spoke with told us that they had worked at the home for a number of years and they knew the people they supported well. They were able to tell us about the care records and how people wanted to be supported. One staff told us, 'We all work together here as a team to make sure people have the care they need.'

Medication was recorded correctly to demonstrate the quantity of medicines in the service and how these had been administered. This meant people could be confident the records matched what had been prescribed to them.