Jemini Response Limited - 17 Jerome Close is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. 17 Jerome Close provides social and residential care for up to three people with learning disabilities and autism. On the day of our inspection there were three people living in the home. People had a range of complex care needs associated with living with autism and some had overlapping conditions such as ADHD, bi-polar disorder and epilepsy. Jemini Response Limited - 17 Jerome Close is owned by Jemini Response Limited and has three other homes in the South East.

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

This comprehensive inspection took place on 16 October 2018 and was announced. The service 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.

At our last inspection we rated the service good. At this inspection we identified a breach of regulations so the overall rating is now requires improvement. Although the care provided was good, the records that demonstrated the running of the service were not up to date or accurate. The provider had recently identified that the systems for monitoring the service were not effective and had started to put in place better systems to monitor the service. We were given assurances following the inspection that these would be tightened up further. However, as care planning and record keeping had not been up to date or accurate, time was needed to fully implement these changes and embed them into everyday practice.

There were enough staff who had been appropriately recruited, to meet people’s needs. Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. Staff understood what they needed to do to protect people from the risk of abuse. Incidents and accidents were well managed. People’s medicines were managed safely.

People’s needs were effectively met because staff attended regular training to update their knowledge and skills. Care staff attended regular supervision meetings and told us they were very well supported by the management of the home. People were encouraged to make decisions and choices. They 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.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with them. People were supported to attend health appointments, such as the GP or dentist. Professionals spoke positively about the service. One health care professional told us, “Staff appear caring and seem to be able to manage clients and their complexities well and with compassion.” People had enough to eat and drink and menus were varied and well balanced.

Staff had a very good understanding of people as individuals, their needs and interests. People were supported to take part in activities to meet their individual needs and wishes. This included trips to the local parks, theatres, cafes and restaurants.

The

Jemini Response Limited - 17 Jerome Close provides accommodation for up to three younger adults who have a learning disability within the autistic spectrum. There were three people living at the home at the time of our inspection. People had a range of complex care needs associated with living with autism. Jemini Response Limited - 17 Jerome Close is owned by Jemini Response Limited and has two other homes in the South East.

There is a registered manager at the home who was also the registered manager for another home owned by the provider in the same Close. 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 told the registered manager two days before our visit that we would be coming. We did this because they were sometimes out of the home supporting people who use the service. We needed to be sure that they would be available in. The inspection took place on 10 and 11 October 2016.

There was an open, transparent and inclusive atmosphere at the home. Staff worked hard to ensure people received a service that promoted their independence, maintained their individuality and developed their well-being. The philosophy of the home was to ensure people ‘felt good’ about themselves. The registered manager had gone beyond what was expected of him as a registered manager to protect people and ensure they maintained a good quality of life.

The registered manager had a good oversight of the home. He worked with staff to promote continual learning and development to improve people’s lives. Staff were aware of their responsibilities and told us they felt well supported by the registered manager and their colleagues.

People were treated with kindness and positive, caring relationships had been developed. Staff knew the needs of people and treated them with dignity and respect. People exercised choice in day to day activities. Staff worked with people to help them reach their goals and achievements and supported them to maintain and improve their independence.

Systems were in place to involve people in making decisions about their care and treatment and people were supported to use these. Staff had a good understanding of people as individuals, their needs, likes and dislikes. Staff were able to communicate effectively with people using their preferred method.

People’s medicines were safely managed and they were supported to receive the medicines they had been prescribed in a way that met their individual needs.

Risks were well managed in ways that enabled people to make their own choices and to remain independent as possible. People were happy and at ease in the presence of staff. Staff were aware of their responsibilities in relation to protecting people from harm and abuse.

There were sufficient numbers of suitably trained staff to keep people safe and meet each person’s individual needs and preferences. Recruitment records showed staff employed were suitable to work at the home. There was a training and supervision programme in place to ensure staff maintained and developed their knowledge and skills.

Staff were able to recognise different types of abuse and told us what actions they would take if they believed someone was at risk. The registered manager and staff had a good understanding of mental capacity assessments (MCA) and Deprivation of Liberty Safeguards (DoLS).

People played an active role in planning, preparing and cooking the main meals at the home. They were supported to eat balanced diets that promoted good health.

People had access to external healthcare professionals when required. They received regular health checks from the dentist, optician and chiropodist.

We met all three people who lived at the house. They all had specialist communication needs and used a range of methods for making their needs known for example, the Picture Exchange Communication System (PECS). We were unable to communicate with the majority of people directly but observed their engagement and communication with staff members to make choices and decisions about their day.

We spoke with three staff and the manager about the delivery of care to people in the house and how this was monitored. Staff told us about how they engaged with the people they supported, the training they received, and opportunities for expressing their views.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We examined three staff files and found that robust recruitment systems were in place and appropriate checks were undertaken before staff began work.

We looked at the arrangements for the supply, storage, administration and safe disposal of medication and found that there were robust systems in place to ensure people’s safety.

We looked at care documentation and monitoring information to support staff feedback and saw that monitoring information was used to inform actions plans and drive improvement.

At this inspection we met one of the three people who lived at the house. They had specialist communication needs that meant we were unable to directly engage in conversation. However, we were able to observe them communicating with staff to make choices and decisions about their day, and to respond to some of the things we asked about.

We spoke with three staff and the manager about the delivery of care to people living in the house, and how this was monitored. We found staff spoken with demonstrated awareness and understanding of the needs of the people they supported and this was reflected in documentation seen. They were provided with appropriate training to ensure they had the skills necessary to support people with challenging behaviour at home or in the community. This ensured they were able to provide the right interventions when necessary, to maintain the safety of the person and others. We looked at care documentation and monitoring information to support staff feedback. We saw that monitoring arrangements and findings from this was used to develop an action plan of improvements.

We viewed the premises and saw that previous structural works had been completed. Each person in the house had a good sized bedroom that was personalised to their specific taste. There was evidence of ongoing investment in the house to maintain and improve it. Fire safety arrangements to meet Fire regulations were underway and also remedial works to the kitchen floor.

Due to communication difficulties and complex behaviour it was difficult for people living in the home to fully engage in the inspection process.

However, one person did confirm that they had been involved in the redecoration of their bedroom and had helped paint the walls.