Archived: Jeian Care Home

Updated 8 September 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by one inspector.

Service and service type

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

The service had two managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. One manager had resigned and deregistered with the Care Quality Commission during the inspection.

Notice of inspection

This inspection was unannounced. Inspection activity started on 20 May 2021 where we carried out the site visit and ended on 11 June 2021.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with two people who used the service and three relatives about their experience of the care provided. We spoke with four members of staff including one of the registered managers. We reviewed a range of records. This included selected plans and risk assessments from five people’s care records and records about people’s medication. We looked at a variety of records relating to the management of the service, including incident forms, and policies and procedures were reviewed.

Updated 8 September 2021

About the service

Jeian Care Home is a residential care home providing accommodation, personal care, and support to 12 adults some of whom may have dementia, at the time of the inspection. The service is one adapted building over two floors accessed by stairs or a lift. The service can accommodate up to 17 people.

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

The registered manager and staff lacked an understanding of what constituted a safeguarding incident and how to deal with it and report it appropriately. A staff member told us they would be reluctant to whistle-blow incidents of poor care or harm. They explained that they would not wish to report on their colleagues. This demonstrated to us a lack of openness and transparency.

Due to a lack of staff training on positive behavioural support, people’s increased anxiety behaviours were dismissed by the registered manager and staff as just, ‘known behaviours’. Staff did not record incidents in enough detail and there was a lack of actions documented. The registered manager did not analyse incident records to look for patterns or trends to help reduce the risk of recurrence of these events.

The registered manager had not made sure appropriate organisations such as the Care Quality Commission (CQC), were informed when incidents happened, and things went wrong. Staff when spoken with had a lack of understanding of what constituted learning from an incident and were reluctant to share examples.

The registered manager had not notified the CQC of incidents they were required to. Relatives told us that although communication was good, when an incident happened such as the outbreak of COVID-19 or an accident at the service, the registered manager and staff did not inform them in a timely manner or in a transparent way.

There had been some improvements made since the last CQC infection control and prevention inspection. However, the registered manager and staff did not always follow up-to-date national guidance on COVID-19 infection control and prevention. We have signposted the provider to resources to develop their approach.

There were missing risk assessments about people’s known risks, including a fire safety risk. Where people had risk assessments and care plans in place, some of these records lacked information to guide staff fully.

There were not enough staff to meet people's care and support needs. Staff worked hard but had become task orientated. Staff had little or no time to engage people with conversation and or activities. This did not promote people’s well-being. People waited too long for personal care support. A staff member when spoken to about people waiting for support demonstrated a lack of empathy to the situation. This was due to the lack of staff, making staff task orientated rather than supportive.

Recruitment procedures were in place to check whether a proposed new staff member was suitable to work at the service.

There was a lack of organisational oversight at the service. The service had a history of not sustaining improvements made. The registered manager could not evidence they were carrying out audits to monitor the service provided and drive improvement. Several documents such as, audits and corresponding action plans were requested by us as part of this inspection, but they failed to supply us with these. Relatives told us they were not given opportunities to feedback and make suggestions on the running of the service.

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 good (published 26 January 2018). Since the last rated inspection an infection prevention and control non-rated inspection was carried out on 17 December 2020. The service was found to be in breach of regulation. 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 improvement had been made around infection prevention and control, but not enough improvement had been made in safe care and treatment and the provider was still in breach of regulations.

At the last inspection the CQC took urgent action to restrict new people being admitted into the service.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The inspection was also prompted in part due to concerns received from the local authority about staffing levels, poor governance systems, poor staff morale and lack of organisational oversight. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

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 improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jeian Care Home 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 the safe care and treatment, staffing, good governance and notification of other incidents at this inspection. This puts people at an increased risk of harm.

Following the inspection, and the identified breaches, we had serious concerns about the quality monitoring systems of this service and so we took enforcement action. The provider is now required to send us a report each month to tell us the actions they are taking to monitor the service and make the necessary improvements.

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 for the provider to understand what they will do to improve the standards of quality and safety. We will also 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is 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.