We carried out an announced comprehensive inspection of this service on 24 July 2018. We rated the service as “Requires Improvement”. After that inspection we received complaints in relation to two people who were receiving personal care service at a supported living accommodation in Barnet. We also received information of concern from the local authority.

As a result of the information received, we undertook a focussed unannounced inspection on 1 March 2019. This report only covers our findings in relation to those topics and requirements we made in the last inspection report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Chiltern Jigsaw Resource Centre on our website at www.cqc.org.uk”

Chiltern Jigsaw Resource Centre is a supported living service for people with a learning disability or autistic spectrum disorder. This service provided care and support to people living in three ‘supported living’ settings, where people were supported to live as independently as possible. One of them was in Harrow and two were in Barnet. At the time of this inspection the service provided care for a total of 11 people.

People’s care and housing are provided under separate contractual agreements. The Care Quality Commission [CQC] does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Chiltern Jigsaw Resource Centre received a regulated activity; CQC only inspected the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the last inspection we found one breach in relation to Regulation17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Good governance. The registered provider did not have an adequate system of comprehensive and regular quality monitoring checks and audits. This may put people at risk of harm or of not receiving appropriate care.

During this inspection in March 2019, we found that although improvements had been made and some deficient areas rectified, there were still some areas where further improvements are needed. Therefore, the service continues to be rated as “Requires Improvement” overall.

We looked at the arrangements for safeguarding people. The service had a safeguarding policy and a whistle blowing policy to ensure that people were protected from harm and abuse. Care workers we spoke with had been provided with training on safeguarding people and knew what action to take if they were aware that people were being abused.

There were arrangements for the administration of medicines. Medicine administration record charts (MAR) and the controlled drugs register had been properly completed. Medicine audits had been carried out. The service had guidance for care workers on when they could administer as required medicines.

Risk assessments had been prepared for people. These contained guidance for minimising potential risks such as risks associated with neglect and behaviour which challenged the service. Care workers were aware of triggers that may cause people to be upset and action to take when people exhibited such behaviour.

There were sufficient care workers during the day shifts to attend to people’s care needs. However, during the night shifts there were insufficient care workers to ensure the safety of people. This was rectified soon after the inspection.

With one exception, the premises were kept clean. One window sill in the bathroom was not clean. The new manager stated that it would be cleaned soon.

Checks and audits of the service had been carried out by the Operations and Business Development Manager and other senior staff of the company. Checks had been carried out weekly and these included checks of the premises, care records and medicines. Audits had been carried out mon

We undertook this announced inspection on 24 and 25 July 2018. Chiltern Jigsaw Resource Centre is a supported living service for people with a learning disability or autistic spectrum disorder. This service provided care and support to people living in four ‘supported living’ settings, where people were supported to live as independently as possible. One of them was in Harrow and three were in Barnet. At the time of this inspection the service provided care for a total of 15 people.

People’s care and housing are provided under separate contractual agreements. The Care Quality Commission [CQC] does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Chiltern Jigsaw Resource Centre received a regulated activity; CQC only inspected the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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 using the service were supported to live as ordinary a life as any citizen.

There was a registered manager in post at the service. A registered manager is a person who has registered with the CQC 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 comprehensive inspection on 16 and 18 May 2017 we rated the service as “Good”. We however, made a recommendation for improvements in quality monitoring in Well Led. During this inspection, we noted that the service did not have evidence of comprehensive and regular quality monitoring of the care provided. As a consequence some deficiencies were not identified and promptly responded to. This may put people at risk of harm or of not receiving appropriate care. We have therefore made a requirement in respect of this deficiency. Careful quality monitoring is essential to ensure that the service is well managed and deficiencies can be promptly attended to.

People who used the service informed us that they were satisfied with the care and services provided. They stated that they had been treated with respect and felt safe with care workers. There was a safeguarding adults' policy and suitable arrangements for safeguarding people. The service kept a record of safeguarding incidents and had co-operated with the safeguarding investigations in ensuring the protection of people. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Potential risks to people had been assessed and strategies were in place to mitigate against these risks. Personal emergency and evacuation plans (PEEPs) were prepared for people. This ensured that care workers were aware of action to take to ensure the safety of people in an emergency.

Infection control measures were in place. Care workers assisted people in ensuring that their bedrooms and communal areas were kept clean and tidy. The service kept a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, fire training and risk assessments.

Care workers were carefully recruited. There was a recruitment procedure and staff records contained evidence that essential checks had been carried out prior to care workers starting work. There were enough care workers deployed to meet people's needs. They had received essential training and were knowledgeable regarding the needs of people. Care workers had been provided with support and supervision.

An incident had occurred in which

We undertook this announced inspection on 16 and 18 May 2017. Chiltern Jigsaw Resource Centre is a supported living service for people with a learning disability or autistic spectrum disorder. It provides personal care for people who live in their own accommodation. At the time of this inspection the service provided care for people living in three small supported living schemes. Two of the schemes were in Barnet and the third was in Harrow.

At our last comprehensive inspection on 13 and 17 May 2016 we rated the service as “Requires Improvement”. We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach was in respect of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment. The registered provider did not do all that was reasonably possible to mitigate against health & safety risks to people. During this inspection, the provider demonstrated that they had taken remedial action to comply with the requirement made. Fire safety arrangements and PEEPS (personal emergency and evacuation plans) were in place and regular checks of the hot water temperatures had been recorded. The second breach was in respect of Regulation 9 relating to Person-centred care. The provider had not ensured that the service only accepted people it could adequately care for. During this inspection, we found that there were arrangements to ensure that people were carefully assessed so that their needs could be met. The third breach was in respect of Regulation 17 relating to good governance. The service did not have effective quality assurance systems for assessing, monitoring and improving the quality of the service. During this inspection, we saw evidence of improvements made. These included a centralised system of audits on medicines, complaints and incidents. We however, noted that that further improvements were needed to ensure that deficiencies were promptly identified and responded to. We have asked th provider to send us an action plan setting out how they will address this.

People who used the service informed us that they were satisfied with the care and services provided. They stated that they had been treated with respect and felt safe with care workers. There was a safeguarding adult's policy and suitable arrangements for safeguarding people. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. People’s care needs and potential risks to them were assessed and documented. Personal emergency and evacuation plans (PEEPs) were prepared for people. This ensured that care workers were aware of action to take to ensure the safety of people.

The service had arrangements for Infection control. Care workers assisted people in ensuring that their bedrooms and communal areas were kept clean and tidy. The service kept a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, staff fire training and risk assessments.

There was a recruitment procedure to ensure that care workers were carefully recruited. There were enough care workers deployed to meet people's needs. They had received essential training and were knowledgeable regarding the needs of people. Arrangements were in place to ensure teamwork and effective communication. Care workers had been provided with support and supervision.

People’s healthcare needs were monitored and arrangements had been made with healthcare professionals when required. The service had arrangements for assisting people with their dietary needs. There were arrangements for encouraging people to express their views and experiences regarding the care provided and management of the service. Care workers prepared appropriate and informative care plans which involved people and their representatives. Regular meetings and one to one sessions had been held for peop

This inspection took place on 13 and 17 May 2016 and was announced. Chiltern Jigsaw Resource Centre is a supported living service for people with a learning disability or autistic spectrum disorder. It provides personal care for people who live in their own accommodation. At the time of this inspection the service provided care for people living in six small supported living schemes. Two of the schemes were in Harrow and the three were in Barnet and one in Enfield. The provider met all the standards we inspected against at our last inspection on 5 January 2016.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

The service had provided care for some people with complex and mental healthcare needs. This meant that some of them required support which other services may not be able to provide. The statement of purpose for the service indicated that they were willing to provide care for people and support them to live as independent a life as possible.

People who used the service and their representatives stated that people had been treated with respect and dignity. The service had a safeguarding adults policy and care workers had received training in safeguarding people. Potential risks to people were assessed and guidance provided to care workers for minimising these risks. People had been given their medicines and no unexplained gaps were noted in their medicines administration charts. We however, noted that the fire safety arrangements were inadequate as PEEPS (personal emergency and evacuation plans) were not in place and there was no documented evidence of weekly fire alarm checks. Regular checks of the hot water temperatures had not been recorded. These measures were needed to ensure the safety of people. These were put in place soon after our visit.

The registered manager and director informed us that the service had undergone a re-organisation of its care workers recently as part of the development plan of the company. This had meant that some care workers had been moved to other supported living units and additional new care workers were recruited. We examined the recruitment records. The records indicated that care workers had been carefully recruited. Care workers had received appropriate training to ensure that they had the skills and knowledge to care for people. They were knowledgeable regarding people’s needs and preferences. Care workers said there was a good staff team. Staff supervision and annual appraisals had been carried out. These ensured that care workers were supported. People informed us that there was sufficient care workers to attend to their needs. In one instance we noted that there was insufficient care workers during the night in one of the places we visited. The registered manager stated that extra care workers had not been commissioned by the care purchasers. They however, informed us soon after the inspection that extra staff had been provided while awaiting funding for extra care workers.

People’s needs had been assessed and detailed care plans were prepared with the involvement of people and their representatives. The provider had employed a behavioural intervention specialist to support care workers in care planning. Reviews of care had been carried out to ensure that the care provided was relevant. People’s physical and mental healthcare needs were monitored and they had access to health and social care professionals to ensure they received treatment and support for their specific needs. Two relatives and four social and healthcare professionals however, stated that the care needs of people had not been met. Two professionals stated that the service had been able to m

This inspection took place on 5 and 6 January 2016 and was unannounced. Chiltern Jigsaw Resource Centre is a supported living service for people with a learning disability or autistic spectrum disorder. It provides personal care for people who live in their own accommodation. At the time of this inspection the service provided care for people living in three small supported living schemes. Two of the schemes were in Harrow and the third was in Barnet. The service also provides a rehabilitation service for people with a learning disability or autistic spectrum disorder who visit the centre during the day. The provider met all the standards we inspected against at our last inspection on 28 November 2013.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

One person and three relatives informed us that they were satisfied with the care and services provided. They informed us that that people who used the service were treated with respect and dignity. The service had arrangements to ensure people were safe. There was a safeguarding adults policy and suitable arrangements for safeguarding people. Potential risks to people were assessed and guidance provided to staff for minimising these risks.

People had been given their medicines and the arrangements for medicines administration was satisfactory. There was a medicines policy and procedure to provide guidance for staff.

There were measures were in place for infection control and staff were aware of procedures to

prevent infection. Protective equipment and hand gel were available.

We saw that there were sufficient staff on duty and they interacted well with people. The staff records indicated that staff had been carefully recruited. Staff had received appropriate training to ensure that they had the skills and knowledge to care for people. They were knowledgeable regarding people’s needs and preferences. Staff supervision and annual appraisals had been carried out. These ensured that staff were supported. A staff member stated that there were times when they were disturbed when they were on “sleeping in duty” and this meant that they were tired when they had to be on duty the next day. The registered manager stated that they had arrangements whereby staff could inform them if they were disturbed during the night and alternative staffing arrangements could be arranged. He agreed to remind staff of this arrangement. A member of staff had worked excessive hours. This may place people and the staff concerned at risk. The registered manager and human resources manager agreed that the staffing arrangements would be carefully planned in future and closely monitored so that this would not re-occur.

People’s needs had been assessed and detailed care plans were prepared with the involvement of people and their representatives. Regular reviews of care had been carried out to ensure that the care provided was relevant. Their physical and mental health needs were monitored and they had access to health and social care professionals to ensure they received treatment and support for their specific needs.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the service. Consultation meetings had been held for people and their representatives. People were encouraged to be as independent as possible and enabled to do their own shopping and prepare their own meals with assistance from staff. The service had an activities programme and a sensory room to provide social interaction and therapeutic stimulation for people.

Staff were aware of the aims of the organisation which were to ensure that people were

Most of the people using the service had complex needs which meant they were not able to tell us their experiences. One of the people who lived at the premises told us that they made decisions about their daily life and what support they needed, and they told us about their plans for the future.

We spoke with a visiting relative of the other person who lived at the premises. They said, “My relative has extreme challenging behaviour and special needs. The staff here are the only people able to handle the whole situation."

The families of people using the service were very involved in their care and support and were able to express their views. The relative who we spoke with told us that they visited two or three times a week, and they were involved in reviews and support plans for the person where they could express their views.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw risk assessments and behaviour management plans that included the triggers for behaviours and how the staff should respond. A behaviour consultant provided guidance for each person on behaviour management and training for the support workers.

Each person had their own team of support workers, and the support that they received varied from one to one to three support staff to one person. This ensured that they were always supported by people that they knew and who knew and understood their needs and behaviours.