Jeian Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service does not provide nursing care. Jeian Care Home accommodates up to 17 older people in one adapted building.

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 s

Jeian Care Home provides accommodation and personal care for up to 17 people, some living with dementia.

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,

Jeian Care Home provides accommodation and personal care for up to 17 older people, some living with dementia.

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 inspection took place on 28 October 2014 and was unannounced.

Jeian Care Home is a residential care service providing accommodation and personal care support for up to 17 older people. On the day of our inspection there were 15 people living at the service.

There was a registered manager in place who is also the registered provider. 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.

People’s safety was compromised in a number of areas. This included the management of people’s medicines and the recording and analyses of accidents and incidents.

The provider did not operate a safe and effective recruitment system. They did not take steps to ensure that staff were honest and of good character. This had the potential to put people at risk as appropriate checks had not been carried out to ensure that staff employed had been confirmed as of good character, honest, reliable and trustworthy.

Staffing levels were insufficient at weekends to meet the needs of people who used the service. The provider did not have a system in place to ensure continuous assessment of staffing levels and make changes when people’s needs changed.

Staff demonstrated they had the required knowledge to be able to safeguard people and report any safeguarding concerns to the relevant safeguarding authority.

Staff had received training in the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). However, the provider did not always follow the principles of the MCA 2005 and was not fully meeting the requirements of the Deprivation of Liberty Safeguards.

People told us their privacy and dignity was respected and made positive comments about care staff. There was insufficient planning to support people’s wishes and preferences regarding how they wanted to be cared for at the end of their life. There was also insufficient planning to promote and support people’s individual leisure interests and hobbies. We were therefore not assured that the planning and delivery of care supported people’s individual needs.

People who used the service could not be assured that the provider properly managed and stored records in relation to their care and treatment in a secure and accessible way. A number of records with regards to complaints and the recording and analysis of accidents and incidents were not available. The provider’s systems for maintaining records required were chaotic and disorganised.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.

We carried out an unannounced comprehensive inspection of this service on 28 October 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We carried out this this focused inspection to check that they had followed their plan and to confirm that they now met legal met legal requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jeian on our website at www.cqc.org.uk

This focused inspection took place on the 15 April 2015 and was unannounced.Following the inspection on the 28 October 2014, we asked the provider to take action to make improvements as we found evidence of major concerns in relation to Monitoring the quality and safety of the service. There was a failure to ensure that service users were protected from the risks associated with improper management of their medicines, operation of staff recruitment, care planning and they did not provide sufficient staff to meet people’s needs. This meant that the safety and welfare of people using the service was at risk and the provider was failing to provide a safe, service. The provider was not meeting the requirements of the law, as they did not protect people against the risks of receiving care or treatment that was inappropriate or unsafe.Jeian Care Home is a residential care service providing accommodation and personal care support for up to 17 older people. One the day of our inspection there were 15 people living at the service.

There was a registered manager in place who is also the registered provider. 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 local authority, quality and improvement team had been supporting the provider to improve the care and support provided to people. They had supported the provider to implement an improvement plan to provide planning for continuous improvement of the service with timescales for actions to be completed.

Action had been taken by the provider to implement a new system for auditing stocks of medicines and checks on medication administration records. This meant that there was a system in place for identifying medication errors.

Following a recent visit from environmental health inspectors the provider had not taken steps as required to maintain standards of hygiene and the kitchen equipment to protect people from the risk of cross infection and provide a safe environment free from the risks of harm. We were not assured that steps had been taken to ensure that people lived in a hygienically clean, well maintained and safe environment free from the risk of cross infection.

There was a lack of assessment carried out to determine people’s mental capacity to consent to their care and treatment. For people living with dementia and other health conditions there was limited information recorded within their care plans.

Staff did not always have access to care plans. This meant they did not have the up to date required knowledge of people’s care needs.

People at high risk of malnutrition, had been provided with access to specialist support and actions had been taken to support people to gain weight. Where advice had been given to weigh people more regularly this had been carried out and recorded and dietary supplements had been provided as prescribed.

Newly employed staff had not been provided with robust induction training and support to enable them to carry out the duties they were employed to perform.

Further work was needed to provide effective monitoring and mitigate risks for people relating to their health, safety and welfare. For example, there was a lack of environmental risk assessments, monitoring of the kitchen cleaning and maintenance of kitchen equipment and a system to ensure a regular review of people’s care and robust care plans review.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we spoke with three people who used the service, five care staff, two visitors and the registered manager. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

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.

The purpose of this inspection was to check that improvements had been made following our last inspection of 11 June 2013.

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.”

The purpose of this inspection was to check that improvements had been made following our last inspection 26 April 2013.

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 spoke with five people who used the service. One person told us, “They (the care staff) are alright here, they don’t interfere with you. We don’t do much.” Another told us, “Staff are usually kind.”

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.

We spoke with five people who used the service. They told us they liked living in Jeian Care Home, were happy with their care and the staff treated them well. One person said, “I would rather live in my home but I can’t it’s not safe. I fell over and it got too much for me. Plus I was lonely. Here I have friends to talk to and the staff look after me.”

We saw that people looked smart and well groomed which showed us their personal care needs were being attended to.

People said that staff respected their privacy and dignity, knocked on their bedroom doors before entering and also helped them to remain as independent as possible.

During our inspection we observed that the staff were attentive to people’s needs. Staff interacted with people using the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance.

We spoke with five people who used the service and they told us they experienced good care and their healthcare needs were met.

We asked people if they were not happy about their care or treatment what they would do and people told us they would speak to their care workers or the registered manager and were confident their concerns would be addressed.

During the visit we observed that the care workers were attentive to people’s needs and that their interaction with people using the service was friendly, respectful and professional.

People told us they enjoyed the activities on offer at the service and that there were different things to participate in each day.

Everyone we spoke with told us they found their care workers honest, reliable and trustworthy.

One person told us the registered manager “comes and checks people are ok. People (care workers) work hard and the manager is hands on”. Another person said “the manager treats everyone the same, doesn’t have any favourites”.