About the service:

41 Jerome Close is a residential care home for up to four people living with a learning disability and/or autism. The organisation also runs three other care homes locally. People living at 41 Jerome Close had learning disabilities and their needs were varied. Some people needed support with living with autism and epilepsy. Some people displayed behaviours that challenged others.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them

People’s experience of using this service:

¿ We made a recommendation to review the specialist training provided to staff to make sure it met people’s needs.

¿ We made a recommendation about the Mental Capacity Act and record keeping related to decision making.

¿ Whilst people’s medicines were managed safely, protocols for the use of as required medicines had not been reviewed and contained inaccurate information.

¿ Recruitment records contained information that had not been explored in detail to ensure staff were safe to work at the service.

¿ There were no records to demonstrate clear oversight of the service. The above three areas were identified as areas that required improvement.

¿ We found improvements had been made to the environment and there were good systems to report any maintenance issues and to ensure they were addressed in a timely manner.

¿ Improvements were also noted in relation to the management of fire safety, evacuations plans had been completed and all equipment was serviced and checked at regular intervals. Regular water testing was completed and a risk assessment had been completed in relation to Legionella.

¿ All areas of the home were clean and there were effective systems to audit in relation to infection control.

¿ There were enough staff to meet people’s individual needs. One person told us they felt safe and people were seen to be comfortable in their surroundings. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Incidents and accidents were well managed.

¿ People’s needs were effectively met because staff had the training and skills to fulfil their role. This included training to meet people’s complex needs in relation to epilepsy, diabetes and behaviours that challenged.

¿ Staff attended regular supervision meetings and received an annual appraisal of their performance.

¿ 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.

¿ People had enough to eat and drink and their menus were varied and well balanced. People’s meals were served in a way that respected their specific needs.

¿ People were supported to take part in a range of activities to meet their individual needs and wishes.

¿ There was a detailed complaint procedure and this was displayed so that anyone wanting to raise a concern could do so.

Rating at last inspection:

Requires Improvement. The last inspection report was published on 03 October 2018.

Why we inspected:

¿ At our last inspection of the service in July 2018 we found breaches in Regulation 12 in relation to safety, Regulation 15, the premises, and Regulation 17 in relation to good governance. We issued warning notices requiring the provider to

This inspection was carried out on 26 & 31 July and 3 & 7 August 2018 and was announced. At the last inspection, the service was rated ‘Good’ overall, with requires improvement in well-led with no breach of the regulations. At this inspection we found these standards had not been maintained and there were a number of significant concerns identified.

Jemini Response Limited - 41 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. The service provides accommodation and personal care for up to four people living with a learning disability or autistic spectrum disorder. There were four people living at the service at the time of our inspection.

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 can live as ordinary a life as any citizen.

The service was not always safe. Environmental risk assessments had not been completed, including for the presence of legionella. Where a risk had been identified this had not been acted on, for example, the need for replacement fire doors. The communal wet room was covered in mould and people were put at risk of infection because of this. The home was dirty and paintwork, décor and floor coverings needed cleaning or replacing. Some maintenance work which had been started was not completed, and there was bare plaster work and unfinished tiling.

The service was not well led. Quality monitoring processes had not identified the issues raised at this inspection. Communication between the registered manager, nominated individual and provider was poor, and the provider lacked oversight of the service. Staff and the registered manager told us they had frequently given verbal feedback about the poor level of maintenance in the home but this had not been acted on. There were no plans in place to make sure maintenance was completed on a regular basis. The lack of planning meant there was risk that immediate safety issues might not be identified and addressed, and ongoing improvements would not be considered. People may have been adversely affected because the provider had not properly considered how the disruption from required maintenance may affect them.

Although there were enough staff to support people to stay safe, there were full time staff vacancies. Recruitment practices were not robust, and not all the relevant checks had been competed before staff began work.

Staff were supported with training, supervision and appraisals to make sure they had the skills they needed to provide good quality care. Specialist training had been arranged where needed, for example, positive behavioural support. Staff knew how to report incidents and accidents, and if these did occur, they were investigated.

Individual positive risk taking was encouraged, and risk assessment and risk management practices to support this were robust. People were supported to eat and drink enough, and specialist dietary needs were met. People could access the healthcare they needed to remain well and their medicines were safely managed. As far as possible, people were protected from harm and abuse. Staff knew how to recognise the signs of abuse and what they should do if they thought someone was a risk.

People continued to be supported with choice and control over all aspects of their lives, and staff supported people in the least restrictive way possible. People led the lives they wanted to able to participate in a wide range of activities and hobbies that interested them.

People experienced care that met their individual needs, and were supported by kind and caring staff. People had their privacy and

Although people were not able to communicate directly with us we saw that people at the home were fully involved in decisions about the support they received.

We saw from observations of people's care and from their care plans that they were assessed regularly and supported in maintaining healthy lifestyles and leading independent and fulfilling lives.

People living at the home were protected from the possibility of abuse by the home's policies and both the quality and training of the staff who supported them.

The home was decorated and adapted to provide appropriate facilities and stimulation for the people living there while maintaining a welcoming atmosphere.

Staff were supported by management and regular training to provide a good level of support. One staff member told us, "We always have enough staff and we have training in autism and Crisis Prevention Intervention (CPI) as well as all the mandatory training."

We examined the home's complaints procedure and found it was effective for visitors and relatives as well as people living at the home.

We met two of the four people who lived at the house. Most of the people living there had specialist communication needs. They 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 were able to speak to one person who was able to tell us about what they were doing that 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.

We found that staff 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 communication difficulties, and deal with incidents of 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 information was used to inform actions plans and drive improvement.

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 was able to tell us that they liked living at the home and liked their room, and had been actively involved in choosing the football themed decor. They told us that they were supported by staff to go out in the community but would also like to do some art and craft work when at home. They said they were able to make their own choices and decisions about their clothes, what they ate and what they did each day.

Jemini Response Limited - 41 Jerome Close provides accommodation for up to four younger adults who have a learning disability within the autistic spectrum. There were four 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 - 41 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 in. The inspection took place on 9 and 12 October 2015.

The quality monitoring and assessing system used was not always effective. It had not identified the issues found during this inspection, including the lack of mental capacity information about people. Where areas for improvement had been identified this were not always acted on in a timely way. There was no mental capacity policy in place and other policies did not contain enough information to guide staff. Maintenance issues were not always addressed in a timely way.

Staff knew people well and treated them with kindness and patience. People were supported to keep in contact with their family and were given opportunities to take part in activities and hobbies that were meaningful to them. There was a positive and open culture at the home. We observed a caring and relaxed atmosphere.

Staff knew how to safeguard people from the risk of abuse. Staff told us and records evidenced they received regular training. Staff said they felt supported by the manager.

The manager and staff had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Medicines were stored, administered and disposed of safely by staff who had been trained to do so. People had access to healthcare professionals when they needed it. This included GP’s, dentists, opticians and psychiatrists

Risk assessments were in place and staff had a good understanding of the risks associated with the people they supported. The plans protected people’s freedom and maintained their independence.

There were enough staff who had been appropriately recruited, to meet the needs of people.

People were given choice about what they wanted to eat and drink, and supported to make their own meals. Meals were nutritious and freshly cooked each day.