We carried out an unannounced inspection of Jah-Jireh on 03 and 05 May 2017.

A comprehensive inspection was last carried out on 01 and 02 March 2016, when we rated the service as ‘requires improvement’ overall and found two breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these were in relation to following safe procedures in the recruitment of staff and assessing risk. At this inspection we found the provider was now meeting the requirements of these regulations.

Jah-Jireh provides accommodation, personal care and nursing care for up to 45 people who are baptised members of the Jehovah's Witness faith. The care home is a purpose built two storey building with bedrooms on both floors. It is situated in a residential area of Wigan close to shops and public transport links. At the time of our inspection there were 39 people living at the home.

At the time of inspection 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.

Each person we spoke with told us they felt safe. Relatives expressed no concerns about the safety of their family members and were positive about the level of care provided. We saw the home had appropriate safeguarding policies and procedures in place, which gave instructions on how to report any safeguarding concerns to the local authority. Staff had received training in safeguarding vulnerable adults and demonstrated a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

We found the home was clean throughout and had appropriate infection control processes in place. Hand hygiene guidance and equipment was located in all the bathrooms and daily, weekly and monthly cleaning schedules were in place which specified the different tasks that needed to be completed and the equipment needed for each task. We saw immediately after the lunch time meal, staff vacuumed the dining room carpet to ensure it was free from crumbs and food items.

Staffing levels throughout the day and night were appropriate to meet people’s needs. Staff, people who used the service and relatives we spoke with confirmed this. A dependency tool was used and updated each month to ensure levels remained safe and effective. The home had considered which times of the day were the busiest and organised rotas based on this information, for example two staff were rota’d to work 8.00 -13.00 purely to assist with bathing during morning routines.

We saw medicines were stored, handled and administered safely and effectively. Staff responsible for administering medicines were trained and had their competency assessed. Audits were completed regularly in a range of areas including administration and recording and we saw evidence these had identified issues and lead to improvements in practice.

Staff demonstrated a sound knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We saw the service was working within the principles of the MCA, and conditions on authorisations to deprive a person of their liberty were being met. Applications had been submitted were required and systems in place ensured re-applications had been made prior to authorisations expiring.

The home was in the process of completing a training matrix after the registered manager identified this was not in place when they commenced working at the home. As this was a work in progress, we noted a number of gaps, however staff confirmed they had completed all required training sessions and we saw a plan was in place to ensure refresh

This inspection took place on 01 and 02 March 2016 and was unannounced.

We last inspected Jah Jireh Wigan on 25 and 26 March 2015 when we rated the home as requires improvement overall and found four breaches of the regulations. The breaches of the regulations were in relation to staffing levels, medicines management, safety of the premises and monitoring the safety and quality of the service. We issued and warning notice in relation to our concerns around staffing, and the provider sent us an action plan to tell us how they would be compliant with the other regulations breached.

We found action had been taken to make improvements and the provider was meeting the requirements of these regulations. At this inspection we identified two breaches of the regulations, which were in relation to following safe procedures in the recruitment of staff and in relation to assessing risk. You can see what action we have told the service to take at the back of this report.

Jah-Jireh provides accommodation, personal care and nursing care for up to 45 people who are baptised members of the Jehovah’s Witness faith. The care home is a purpose built two storey building with bedrooms on both floors. It is situated in a residential area of Wigan close to shops and public transport links. At the time of our inspection there were 33 people living at the home.

There was a registered manager in post at the time of the inspection. 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 was due to retire shortly after our visit and an existing member of staff had been successful in applying for the manager’s post.

The day prior to our inspection visit the service had changed the function of some of the communal areas to create a new quiet dining area and a larger lounge-diner. This appeared to have worked well and we received positive comments from people living at the home.

The meal-time experience was positive and we saw people were supported to eat and drink as required in a dignified manner. The home was catering to meet people’s dietary preferences and requirements.

The environment at the home was clean and safe. People told us they felt safe living at the home, but some people commented that they thought more staff were required. Two people we spoke with told us there could be delays in receiving support. We found some people were not supported to get up from bed until around 10:30, which staff told us was due to their support needs. Other than this, during the inspection we saw people received support in a timely manner. Staff told us changes had recently been made to procedures and staff were allocated to provide support to certain individuals. The registered manager told us they were also encouraging staff to take breaks in the communal areas to help ensure there was sufficient cover for these areas.

People told us their spiritual needs were well met by the service. A range of spiritual activities took place including letter writing with the local congregation, and a ‘link-up’ with services at the Kingdom Hall.

Improvements had been made to make the environment more accessible to people living with dementia. This included directional and pictorial signs, and some people had their photos on the door of their bedroom to help them identify it. Further improvements were planned and the service was seeking guidance on developing the service for people living with dementia from an external professional. Staff had received training in dementia care and we received positive feedback from a health professional who told us they had seen a positive change in staff attitude and approach following this training.

Staff told us the provision o

We carried out an unannounced inspection of Jah Jireh Charity Homes Wigan on 25 and 26 March 2015. We last inspected the service on 8 September 2014. At this time we found the service was not meeting standards in relation to staffing levels. At our inspection on 25 and 26 March we found the service was still not meeting requirements in relation to staffing levels.

Jah-Jireh provides accommodation, personal care and nursing care for up to 45 people who are baptised members of the Jehovah’s Witness faith. The care home is a purpose built two storey building with bedrooms on both floors. It is situated in a residential area of Wigan close to shops and public transport links.

At the time of our inspection 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.

We found four breaches of the regulations in relation to staffing levels, medicines, safe premises, and monitoring the safety and quality of the service. You can see what action we told the provider to take at the back of this report.

There were not always sufficient staff on duty at Jah Jireh to meet people’s needs. The service had increased staffing levels since our last visit, however agreed staffing levels were not always achieved due to shifts not being covered when staff were on annual leave or off with illness. We were told the needs of people living at the home had also increased adding extra pressure to the staff team.

The environment was not always safe for people living at Jah Jireh. The water felt very hot and temperatures were not tested to ensure peoples’ safety before bathing them. We saw a section of missing carpet exposing a manhole with a loose fitting cover in one area of the home, which created a trip hazard.

Adaptations had not been made to make the environment dementia friendly. Doors were painted the same colour and there were no signs to indicate what rooms the doors led to. This would make it more difficult for people with dementia symptoms to retain independence or orientate in their home. We have made a recommendation in relation to dementia friendly environments.

Medicines were not always kept safely as the service had not consistently monitored the temperature of medicines kept in the fridge. We also found a loose tablet in a bathroom that was accessible to people living at Jah Jireh.

The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We found the service was submitting DoLS applications to the local authority where a need was identified.

We saw people were not always given support when they requested it at meal times. We found that one person was not receiving support at meal times that was consistent with their care plan.

We were told an effective and thorough handover was always given to ensure staff were aware of current support needs. However care plans were not always up to date and consistent with the care being provided to people. This increased the risk of inconsistent or inappropriate care being given.

Staff told us they felt well supported by the managers and colleagues. We saw staff undertook training in areas including safeguarding, health and safety and MCA/DoLS. New staff worked supervised until they felt confident and were deemed competent by a supervisor. Staff also spoke positively of team meetings, which they told us were full of training and provided opportunity to feedback to the manager.

Most of the interactions we observed between staff and people living at Jah Jireh were respectful and friendly. However, staff had little time to spend with people at busy times such as mealtimes.

Whilst some people felt there were enough activities, others said there was not enough to do and some people said they would like more trips out. Staff told us there would be more trips in the summer when the weather was warmer. People’s spiritual needs were well met and there were close links with the congregation as well as regular trips to the Kingdom Hall.

There was not a robust system of audit in place that would have allowed the manager to monitor the quality and safety of the service being provided. There were no care plan or medicines audits carried out by the manager, which were areas where we identified shortfalls.

This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

We asked the following five questions.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

Most of the people we spoke with who lived in the home and their relatives were pleased with the care provided and felt their views were respected and listened to. One person said: “It’s the best place going.” Another person said: “I feel safe.” The staff worked in a safe and hygienic way and used appropriate protective clothing.

Some of the staff, people who lived in the home and relatives we spoke with felt there was not enough staff to meet the needs of the people who used the service. A member of the management team was available on call in case of emergencies. One relative said: "Sometimes there has been a shortage through illness." Another person said: “I don’t think there is enough staff.”

The business manager and the staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any incidents of abuse.

Is the service effective?

People told us they were happy with the care that had been delivered. A person who lived in the home said: "They do their best." A relative said: "They look after me too."

Care records confirmed people's preferences, interests and needs had been recorded and care and support had been provided in accordance with people's wishes. One person said: "They never refuse us anything."

We heard information was shared very effectively between staff. Several ways of sharing information included handovers, daily records, and monthly reviews with relatives.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and encouragement when supporting people. One relative said: "They are very, very caring." One person who used the service said: "I think they are wonderful."

Is the service responsive?

People's needs had been assessed before they were admitted to the home. Their needs were carefully described so care workers knew exactly what tasks to undertake to support them. Changes in people's care needs were reported to the nurse team leader and they briefed care staff at handovers and via the updated care plans. One relative said "They are very good, very fair." They also commented the chiropodist, the speech and language therapist, the dietician visited regularly and a doctor visited weekly. They felt their relative was receiving good care from the team.

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. People told us they had received customer satisfaction surveys and that staff listened to their concerns. The manager met informally with families and we saw notes of these meetings indicating feedback was given about improvements made in response to people’s suggestions. The manager was also readily available whenever relatives visited.

Staff told us they were clear about their roles and responsibilities and said they felt supported by management. One person said: "They listen. They are kind and caring."

We spoke to twelve people living at Jah-Jireh and two visitors during our visit. The people using the service who were able to tell us said that they were happy living in the home. Comments included; “This is a very good home”, “it is wonderful here” and “it is lovely here”, “they are lovely and always treat me with respect” and “the staff are very good.”

A visitor told us; “it is wonderful, I feel my relative is safe here.”

The menu provided a degree of flexibility for people and in practice it meant that at any mealtime it was likely that everyone was able to eat something they had chosen.

The home had an adult protection procedure designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.

The provider had taken appropriate steps to ensure that there were safe recruitment procedures in place and that people who were not suitable to work with vulnerable adults were not employed within the service.

Staff members completed an induction when they started work at the home; a new staff member confirmed this during our visit. We also looked at staff training and saw that mandatory and other training in areas such as safeguarding, moving and handling, dementia care and palliative care was being provided.

Information about the safety and quality of service provided was gathered on a continuous and on-going basis.

We spoke with six people living at a Jah-Jireh Charity Homes – Wigan. People were very complimentary about the care they received. We were told “We are looked after very well”; “If you do not want to go to bed at night, they will come back and ask you again”; "I feel safe with all of the staff here” and “I have no problems at all with the staff.”

We found that people were given choices about their care and all of the people we asked told us they felt safe at Jah-Jireh. Staff told us that they felt supported and that they received appropriate training. People living at Jah-Jireh told us they thought staff were competent to undertake their roles.

We found that people had detailed assessments completed on most occasions but we found that the information obtained was not always used to plan appropriate care for people.

We looked at complaints during our visit and found that there had been no complaints made since the service was registered under the Health and Social Care Act in 2010. The service had a complaints policy and we saw that comments and compliments about the service were recorded.

We found that overall people at Jah-Jireh Wigan enjoyed living there. People felt safe and said that their physical and spiritual needs were met. We also found that some people would like activities more suited to their individual interests or age group.

Comments included:

“In general things are pretty good, the staff are good and we help each other, it’s our Christian way.”

And

“They’re very obliging and they know what they’re about.”

We found that in the main the support and care provided met peoples needs.

We used the Care Quality Commission “Short Observational Framework for Inspectors” tool (SOFI) during this review. This involved observing and recording the activities and interactions for a group of service users over a set period of time.