Archived: Jeian Care Home

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.

We were not assured that this service met good infection prevention and control guidelines.

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 were so concerned about the risks to people that we took urgent enforcement action to restrict admissions to the home and to require the provider to take immediate action to improve the infection control processes.

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.

There were 17 people living in the service when we inspected on 9 January 2018. This was an unannounced comprehensive inspection.

The previous registered manager had left the service in October 2017. There was a new manager in post who had started working in the service on 17 November 2017. They were in the process of completing their registered manager application. 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 our last inspection of 8 February 2017 we found that some improvements had been made following our previous inspection of 17 March 2016, which were ongoing and needed to be sustained. There were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated requires improvement overall. The key questions for Safe, Effective, Responsive and Well-led were rated as requires improvement and Caring was rated as good. Improvements were needed in the way that people’s care records reflected how their care was assessed, planned for and met, how people’s food and fluid intake was monitored, and the arrangements for staffing. During this inspection of 9 January 2018 we found that the improvements had been sustained and further improvements implemented.

You can read the report from our last comprehensive inspections, by selecting the 'all reports' link for Jeian Care Home on our website at www.cqc.org.uk.

Improvements had been made in how the service supported people who were at risk of developing pressure ulcers. There were systems in place designed to keep people safe from avoidable harm and abuse. There were systems in place to administer medicines safely and to maintain records relating to medicines management.

Improvements had been made in the ways that the staffing in the service was organised to ensure that people were provided with assistance when they needed it. Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service. Staff were trained and supported to meet people’s needs effectively.

Improvements had been made in the infection control processes in the service and in the environment.

People’s nutritional needs were assessed and met. Improvements had been made in how staff recorded and monitored the amounts that each person had to drink and eat each day, where required. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. Staff worked with other professionals involved in people’s care to provide people with an effective and consistent service.

Improvements had been made in people’s care records. They provided comprehensive guidance for staff on how people’s assessed needs were met. Improvements had been made in people’s daily records which now included their wellbeing and mood. People were provided with the opportunity to participate in activities that interested them.

Improvements had been made in the service’s quality assurance processes which were used to identify shortfalls and address them. In the short time that the manager had been working in the service they had made improvements. They had plans in place to make further improvements. There was a system in place to manage complaints and these were used to improve the service. Where incidents had occurred the service had systems in place to learn from these and use the learning to drive improvement in the service.

People were treated with respect and compassion by the staff working in the service. People had positive relationships with the staff who supported them. People’s views were listened to, valued and used to plan and deliver their care. People’s views were listened to and acted upon relating to their end of life care. There were systems in place designed to support people to have a pain free and dignified death. 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.

There were 16 people living in the service when we inspected on 8 February 2017. This was an unannounced inspection.

There was no registered manager in place. 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. A new manager was employed in the service since August 2016, their registered manager application was being processed.

At our comprehensive inspection of 17 March 2016, we found there were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, we found that improvements were needed in the environment, protocols for when people were prescribed with medicines to be administered as required, how people gave their consent to the care they were provided with and how people’s care was assessed and planned for. The previous registered manager had made improvements in how the service monitored and checked the service provided and this needed to be embedded in practice. During this inspection we found that the new manager had continued with these improvements, however, these were not yet fully implemented and sustained.

You can read the report from our last comprehensive and focused inspection, by selecting the 'all reports' link for Jeian Care Home on our website at www.cqc.org.uk.

Improvements had been made in people’s care records. Further consideration of how to provide increased guidance to staff would ensure that people were provided with good care at all times. Improvements were needed in how staff recorded in people’s daily records to include their wellbeing and mood.

Improvements had been made in the service’s quality assurance processes which were used to identify shortfalls and address them. In the short time that the manager had been working in the service they had made improvements, some were ongoing and they were aware of further improvements needed and these were in progress. There was a system in place to manage complaints and these were used to improve the service.

People’s nutritional needs were assessed and met. However, improvements were needed in how staff recorded the amounts that each person had to drink and eat each day, where required.

There were systems in place to administer medicines safely and to maintain records relating to medicines management. Staff were now provided with guidance on when medicines that were prescribed when required should be administered. Further improvements were needed to ensure that the storage of people’s creams in their bedrooms was safe.

There had been recent changes in the staffing in the service and active recruitment was taking place. However, during the time new staff were waiting to start some existing staff were working long hours. The manager was aware of this and assured us that this was in the short term.

Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service.

People were provided with the opportunity to participate in activities. People were treated with respect and compassion by the staff working in the service.

There were systems in place to keep people safe, this included appropriate actions of reporting abuse. Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse.

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 were trained and supported to meet people’s needs effectively.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

There were 15 people living in the service when we inspected on 17 March 2016. This was an unannounced inspection.

We carried out a comprehensive inspection on 28 October 2014 and the service was rated as inadequate. A further focussed inspection was carried out on 15 April 2015 and found that some improvements had been made, the service was rated as requires improvement and breaches of legal requirements were found. After the focussed inspection the provider wrote to us to say how they were going to meet the legal requirements in relation to the breaches. During this comprehensive inspection on 17 March 2016 we checked that the provider had followed their improvement plan and were meeting legal requirements.

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.

There were procedures and processes in place to ensure the safety of the people who used the service. Risk assessments provided guidance to staff on how risks to people were minimised. There were appropriate arrangements in place to ensure people’s medicines were stored and administered safely. Improvements were needed in protocols for when medicines prescribed as required should be administered.

Improvements had been made in the environment and these were ongoing.

Staff were trained and supported to meet the needs of the people who used the service. Staff were available when people needed assistance, care and support. The recruitment of staff was done to make sure that they were able to work in the service.

The service was up to date with the Deprivation of Liberty Safeguards (DoLS). However, improvements were needed in how people’s consent to their care was recorded. People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

People were provided with personalised care and support which was planned to meet their individual needs. Improvements were needed to document how people, or their representatives, were involved in making decisions about their care and support.

A complaints procedure was in place.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. Improvements had been made in the governance of the service and how they assessed the quality of the service provided. However, the service had been supported in making these improvements by the local authority. These improvements needed to be maintained and embedded into practice and the leadership needed to independently identify shortfalls and address them to provide people with good quality care at all times.

This is the summary of what we found:

Is the service safe?

People told us that they felt safe. The manager and staff had been trained in understanding their roles and responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However, at the time of our inspection no applications had been submitted.

There were sufficient numbers of staff to meet people's needs. People, who used the service, care staff and visitors all told us that they considered staff were available when they needed them. Two people told us that staff always responded to their call bells promptly.

Specific risks had been assessed and a plan was in place to reduce these risks. This meant that staff had guidance with action plans describing how to keep people safe.

Staff received training in safeguarding people from abuse and were aware of their responsibilities to refer concerns to the appropriate safeguarding authority.

Is the service effective?

People's health and care needs were assessed in consultation with either the person themselves, relatives or their advocate. People had a plan of care in place that reflected their healthcare needs in conjunction with support from external professionals, where required.

A recent environmental health department report showed us that the provider had improved food hygiene practices.This assured us that the provider had taken steps to keep people and staff working at the service safe with the recent implementation of effective management monitoring audits.

Is the service caring?

People told us they were supported by staff who were kind, caring and respectful. One person told us, 'They are all very nice to you here, not nasty but nice.'

We observed care workers supported people with patience and genuine affection and in a dignified manner.

Is it responsive?

People's care records showed that where concerns about an individual's wellbeing had been identified, staff had taken appropriate action that ensured people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor, dieticians and community nurses.

People, who used the service, care staff and visitors all told us that they considered staff were available when they needed them. People told us that staff responded to their call bells promptly.

Activities provided were limited to those provided by care staff with occasional visits from outside entertainers. People we spoke with told us they would benefit from more opportunities to go out into the community.

Is the service well led?

The manager told us the service was fully staffed and that staff sickness was managed well from within the existing staff team. The manager was covering vacant shifts which meant that they did not always have the time to implement the changes they wanted to improve the quality of the service.

Staff we spoke with were positive about the leadership of the service and said that they felt well supported.

We saw that health and safety checks had been regularly carried out. A recent environmental health department report showed us that the provider had improved food hygiene practices.

During our inspection of the service on 11 June 2013 we had moderate concerns about the management of medicines. The provider did not protect people against the risks associated with the unsafe use and management of their medicines, by means of making appropriate arrangements for the recording, handling and safe administration of people's medicines.

During our inspection we found that there had been improvements made in people's care records and the handling of medicines.

We spoke with three people who used the service who told us they were satisfied with the service they were provided with and the staff treated them well. People told us they did not have any concerns about the way their medicines were handled and said they received their medicines in a timely manner. One person said, 'I do not have to wait for my tablets and if I tell them I am in pain they give me my paracetamol as soon as I need it.'

During our inspection of the service on 26 April 2013 we had major concerns about the management of medicines. The provider did not protect service users against the risks associated with unsafe use and management of their medicines, by means of making of appropriate arrangements for the recording, handling, using, safe keeping, dispensing and safe administration of medicines. We issued a warning notice on 13 May 2013 requiring the provider to become compliant with this regulation by 31 May 2013. We received an action plan from the provider telling us what they would do to become compliant.

We found that there had been some improvements made since the last inspection in the management of people's medicines. However, during this inspection we found there were still medication errors which we judged to have a minor impact on people who used the service.

During this inspection we found some improvements in the recording of people's care records in relation to their finances and belongings brought with them when moving into the service.

We spoke with two people who used the service. People we spoke with were complimentary about the care and support they received. One person told us, "The majority of staff here are kind and helpful.'

We looked at the care records of three people who used the service. There was information about people's health in their care plans. Daily care records recorded requests for and visits from healthcare professionals.

We looked at how the service provided for the nutritional needs of people who used the service. One person told us, 'The food here is pre-prepared food; it's monotonous and tastes bland. I miss proper homely cooked food. Some of its good but often it's bad.' Another told us, 'The food is ok, I have no complaints.'

Prior to our inspection we received a concern about the management of people's medication. As part of our inspection we looked at how information in medication administration records and care notes for people living in the service supported the safe handling of their medicines. Suitable arrangements were not in place for the management of people's medicines.