Archived: Jabulani

Jabulani is a residential care home providing accommodation and personal care for people with learning disabilities, autism, physical disability, mental health conditions and sensory impairment.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 11 people. Eight people were using the service. This is larger than current best practice guidance.

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

Practice at the service placed people at risk of harm. We found the building was cold throughout the inspection and the hot water in some people’s bathrooms did not reach suitable temperatures. Where people and relatives had raised concerns of inappropriate care or treatment, these were not always followed up or investigated. People did not always receive their medicines as prescribed. Safeguarding was not always given sufficient priority. We found examples of people telling staff or management they had been verbally or physically abused. These had not always been investigated. The provider could not demonstrate that staff had been safely recruited.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service rarely 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 did not fully reflect the principles and values of Registering the Right Support for the following reasons, lack of choice and control, limited independence and limited inclusion.

Care and support plans did not reflect the most recent evidence-based guidelines or best practice guidance. Staff were not adequately trained, and some did not have the skills or competency required. There was not always bespoke training to teach staff how to meet people’s individual needs. For example, where people had certain health conditions or autistic spectrum disorder, staff had not received training to meet their individual needs.

Privacy and dignity were not respected, this included when people were asleep. People’s independence was not promoted. People were not supported to enhance their life skills. For example, they could not go into the kitchen unless staff unlocked the door for them. The provider did not make independent advocacy available to people. The registered manager showed a lack of understanding about independent advocacy. Staff were instructed to be task focused and companionship was not promoted.

People did not have choice and control of their own lives. People had restrictions on their freedom that were not assessed and had not been agreed as in their best interest. People were not always supported to follow their interests or to take part in activities that were relevant to them. Visiting restrictions had been put in place on relatives and people who had raised concerns had been told they were no longer allowed to enter the premises. This meant some people were unable to spend time with their families in the home. The provider’s response to complaints did not demonstrate they took people’s complaints seriously and treated them with equality.

People told us the service was not well-led. There were low levels of staff satisfaction and the provider did not demonstrate an understanding of the importance of promoting people’s human rights. This meant people’s needs were frequently overlooked. Staff told us the newly appointed registered manager offered them more support than they had experienced before but staff, relatives and some professionals raised concerns with us about the conduct and manner of other senior members of the management team. Feedback we received was that people, staff, relatives and professionals at times felt intimidated, victimised and bullied. Systems and processes to assess, monitor and improve the quality and safety of services provided were ineffective.

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 (published 03 October 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of regulations. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.

The service remains in special measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to person-centred care, dignity and respect, safe care and treatment, safeguarding people from abuse and improper treatment, handling of complaints, good governance, staff training and recruitment of staff at this inspection. In response to this we served notice of our decision to cancel their registration with CQC. This action has now been completed and the provider is no longer able to provide accommodation for people who require nursing or personal care from this location.

Jabulani is a residential care home providing accommodation and personal care for people with learning disabilities, physical disability and sensory impairment. The service is one adapted building with nine en-suite bathrooms, there is a lift which allows access between the ground and first floors.

The service is bigger than most domestic style properties. It was registered for the support of up to 11 people. Ten people were living there at the time of the inspection. This is larger than current best practice guidance.

The service did not apply the principles and values of Registering the Right Support and other best practice guidance. These were designed to 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.

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

Practice at the service placed people at risk of avoidable harm. Bathing facilities were not fit for purpose to safely meet the needs of some of the people living there. The physical environment was not decorated or adapted to a consistent standard to meet the needs of people living with physical disability.

Risks to people’s safety were not always assessed, mitigated or managed. Risk assessments weren’t always in place. Some risk assessments were old and had not been reviewed in line with people’s changing needs.

The provider did not have a credible statement of vision and values. Roles, responsibilities and accountability arrangements were not clear. There were a lack of governance and auditing systems and processes.

Medicine documentation was not always clear. Some people’s medicine administration records were missing or out of date.

There was limited use of systems to record and report safety concerns, near misses, accidents or incidents.

Safeguarding referrals were not always given sufficient priority. Some incidents had not been referred to the local authority safeguarding team.

There were enough staff, however they were not always deployed effectively to safely carry out their role. For example, there were no team leaders on night shifts which meant staff needed to call an on-call member of staff if someone required medicine administration.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The physical environment was not decorated or adapted to a consistent standard to meet the needs of people living with physical disability.

People’s privacy and dignity were not always respected. There was a lack of systems to identify and therefore protect people against lack of privacy and dignity.

People were not always supported to express their views about their own care. There were times when this had been done in a way that the person was unable to engage with.

People’s equal and diverse needs and preferences were not always documented or explored. Although people were not discouraged from expressing their individuality.

Care planning was not robust enough to empower staff to ensure people had choice and control.

Information was not always provided in a way that people could understand.

Staff were kind and caring, we saw pleasant interactions and that people appeared to enjoy the company of the staff during the inspection.

Infection prevention and control procedures were in place and the home was clean and free from malodours.

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 June 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, documentation, staff training and managerial support provided to staff. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the full report.

After the inspection, in response to the concerns we raised, the provider contacted an occupational therapist to review the safety of the bathing facilities for some people living there. The occupational therapist confirmed that people were not safely assisted to bathe and the facilities were not fit for purpose. The provider told us they adopted the recommendations made, implemented short term measures to assist people to bathe safely and would then address the long-term plans to improve facilities at the service.

Enforcement

We have identified breaches in relation to person-centred care, dignity and respect, the need for consent, safeguarding people from abuse and improper treatment, the premises and equipment and good governance at this inspection.

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

Since the last inspection we recognised that the provider had failed to notify us of certain incidents. This was a breach of regulation. 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 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 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.

Jubalani 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. Jubalani accommodates up to 11 people in one building. On the day of our inspection 10 people were using the service, one person was in hospital.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection in April 2015, we rated the service ‘Good’. The service remains ‘Good’.

The service is required to have a registered manager and one was in post. 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 a registered manager.

During this inspection we found the service was mostly safe during the day. However, medicines were not always stored effectively and the number of staff working at night left people at risk.

People were protected from risks associated with their care and support. Action had been taken to protect people from the behaviour of others living at the home, this included increasing the staffing levels. Systems to review and learn from accidents and incidents were in place. The manager worked closely with mental health professionals and social care professionals and risk assessments were on going. Staff were trained in systems to keep people safe and prevent them from harming themselves and others.

Staff understood infection control and there were systems in place to keep people safe and the home clean and fresh.

Where people lacked capacity to make choices and decisions, their rights under the Mental Capacity Act (2005) were respected. DoLS were used legally and effectively to protect people who did not have the mental capacity to consent to their care.

Staff felt supported and received sufficient training to enable them to effectively meet people’s individual needs. People’s mental and physical health was promoted and they were supported to attend health care appointments. People were supported to have enough to eat and drink.

People received person centred support which met their needs. Staff had an understanding of how to support people with mental health needs and all staff had read and understood people’s care plans. Policies and practices were person centred. Staff respected people’s privacy and their dignity was promoted.

People had care plans that provided an accurate and up to date description of their needs. People’s independence was promoted in a proactive manner, and some people were being assisted to move to more independent living.

People knew how raise issues and concerns. People had opportunities to partake in social activities in the community during the day. This was curtailed at night due to the timings of staffing rotas and shift changes.

The service was well led. The systems in place to monitor and improve the quality and safety of the service were effective. These included systems to record, analyse and investigate incidents which posed a risk to the health and wellbeing of people who used the service. Staff on duty when an incident happened, had a meeting to look at the events and lessons to be learned and actions to put in place to mitigate risk. Swift action was taken in response to known issues. Staff felt supported and were able to express their views in relation to how the service was run. People’s human rights were respected and people were supported to explore their sexuality.