Jasmine at Primrose

Jasmine at Primrose is a short term respite care service which specialises in supporting people with a learning disability and specialist healthcare needs, such as epilepsy, autism or a sensory impairment. At the time of this inspection thirty six people in the community accessed the service for respite care. The service was able to accommodate up to seven people at any one time. People can choose to spend anywhere between one to ten nights at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

People were safe at the service. Staff were trained to safeguard people from abuse and knew how to minimise identified risks to people’s safety. Health and safety checks were carried out of the premises and equipment to make sure they were safe. The premises was clean and tidy and provided a range of comfortable spaces for people to spend time in. Staff followed good practice when providing personal care and when preparing and handling food which reduced hygiene risks.

There were enough staff to support people. The provider carried out pre-employment checks to make sure new staff were suitable to support people. Staff were given relevant training to help them meet people’s needs. They were supported by the provider to review and continuously improve their working practices so that people would experience high quality care and support

People and their relatives contributed to planning the support people needed during their stay. People had current care plans which set out how their care and support needs should be provided. Their needs were met by staff.

Staff used people’s preferred method of communication when interacting and engaging with them. Staff were warm and friendly and knew people well. They supported people in a dignified way which maintained their privacy and independence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff helped people stay healthy and well. They supported people to eat and drink enough to meet their needs and to take their prescribed medicines. Staff worked well with other healthcare professionals to ensure a joined-up approach to the care people received.

People and their relatives had no concerns about the care and support provided by staff. They knew how to make a complaint if needed. The provider investigated accidents, incidents and complaints and kept people involved and informed of the outcome. Improvements were made when needed and learning from investigations was shared with staff to help them improve the quality and safety of the support they provided.

People, their relatives and staff were encouraged to have their say about how the service could improve. The provider used this feedback along with other checks, to monitor, review and improve the quality and safety of the support provided. Senior staff were acting to make improvements at the time of this inspection to activities, the menu and records maintained by staff. They worked proactively with other agencies and acted on recommendations to improve the quality and safety of the service for people.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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 7 April 2017).

Why we inspected

This inspection was planned based on the previous rating of ‘Good’.

Follow up

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our inspection schedule or in response to concerns.

The home had 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. The registered manager assisted us during our inspection.

There were sufficient staff deployed in the service and staff worked flexibly to meet people’s needs. Prior to starting work at the service recruitment checks were completed to help ensure only suitable staff were employed. Training was provided which staff told us gave them confidence in their role. Regular supervision was provided to staff to monitor their performance and staff appraisals were completed annually.

People were protected from the risk of harm as systems were in place to keep them safe. Risk assessments were completed which identified control measures to mitigate the risks. Accidents and incidents were monitored and action taken to keep people safe. Staff had a clear understanding of how to safeguard people and knew what steps they should take if they suspected abuse. Each person had a personal evacuation plan in the event of an emergency.

Medicines were managed well and records showed that people received their medicines in accordance with prescription guidance. Where people’s health needs changed staff involved appropriate professionals. People were supported to have a nutritious diet and were able to make choices regarding what they had to eat and drink. People’s legal rights were protected. Capacity assessments were completed and where best interest decisions were made relevant people were involved in the decision.

People were supported by staff who showed kindness and care. Their dignity and privacy was respected by staff and people were able to choose where they spent their time. Staff had a good understanding of people’s communication needs. People were supported to maintain their independence and could make their own decisions.

Each person had an individualised support plan in place which detailed their needs and preferences. These were updated and reviewed each time a person used the service. Staff were knowledgeable about people’s needs and we observed people’s likes and dislikes were respected. People were able to access their preferred or regular activity when staying at the service and families were encouraged to meet with the staff and made to feel welcome.

Feedback on the quality of the service provided was obtained from people’s relatives. A complaints policy was in place and relatives told us they were confident if they were unhappy about anything it would be addressed.

Relatives and staff told us they felt the service was well-led and that the registered manager was approachable. Regular audits of the service were completed to monitor the quality of the service provided. Action was taken to address any concerns identified.

This was an unannounced inspection which took place on 16 March 2016.

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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

There were an insufficient number of staff to support people to undertake individualised activities or to go out when they wished. We received mixed feedback about the management of the service. Some staff said they did not feel as supported as they would like to. The registered manager told us they did not know people as well as they would like to.

Proper medicine management procedures were followed by staff. Storage of medicines was good and records related to medicines were completed correctly. However, there was a lack of protocols for people who required medicines on an ‘as required’ basis.

People’s individual risks had been identified by staff, although guidance for staff on how to manage these risks were not always easily available to staff.

People were cared for by staff who were extremely kind and attentive. Staff encouraged people to participate in tasks in the home during the day. People were able to make their own choices. Relatives were very involved and consulted all the time in relation to their family members care.

There was a programme of training for staff which help them to feel confident in their role. Staff had the opportunity to meet with their line manage on a regular basis to discuss all aspects of their work as well as to undertake training specific to the needs of people.

Where people had specific dietary requirements staff were aware of these and made sure people were provided with appropriate food or support. Staff helped people access external healthcare professionals when they needed to.

Accidents and incidents that occurred were recorded and monitored by staff. There were very few incidents at the service. Staff understanding of safeguarding and what to do if they suspected abuse was taking place was good.

Should the service have to close staff had a contingency plan available to them to help ensure people’s care would not be compromised. Good recruitment processes were followed to help ensure people were cared for by staff who were suitable to work at the service.

The correct procedures were being followed by staff in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). As people generally stayed for short-term respite staff followed the Trust policy on submitting DoLS applications.

People had a pre-admission assessment before they used the service and this formed the basis of a person’s care plan. Care plans were reviewed each time a person came to stay at Jasmine at Primrose. Complaint information, in an appropriate format, was available to people and their families.

Quality assurance checks took place to help ensure people were receiving the best care possible in the most appropriate environment. Staff were involved in the service through regular staff meetings and parents were encouraged to give their feedback.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have also made some recommendations to the registered provider.