The inspection took place on 7 June 2018 and was unannounced. The service was last inspected on 22 March 2016, where we found the provider to be in breach of one regulation in relation to safe care and treatment due to not maintaining safe medicines storage. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question Safe to at least good. At the inspection on 7 June 2018, we found that the provider had made some improvements but they were not sufficient and they remained in breach of Regulation 12. This is the first time the service has been rated Requires Improvement.

The Jennifer Home accommodates up to six adults with a learning disability, autistic spectrum disorder and mental health needs. The service is set in an adapted terraced house spread over three floors. The basement floor comprises communal areas including an open plan kitchen and dining room and a living room. At the time of our inspection, four people were living at the service.

The Jennifer Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this 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 and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in post. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider did not have robust systems to ensure people were protected against harm. Risks associated to people’s health and care needs were not always appropriately identified and mitigated. Staff’s criminal record checks were not renewed as per the provider’s policy. Staff did not always maintain accurate incident records. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the systems in the service did not always support this practice. Staff were not sufficiently trained to meet people’s individual needs effectively. The provider did not always provide supervision and annual appraisals in line with their policy. Staff did not maintain accurate daily care logs for weekends.

People told us they felt safe with staff. Staff knew how to safeguard people against abuse. The provider stored medicines safely and securely. Staff were aware of people’s needs and how to provide safe care. Staff followed appropriate infection control procedures to avoid cross contamination. Health and safety records were in date.

People’s nutrition and hydration needs were met and told us they liked the food. Staff supported people to maintain good health and ensured they had access to ongoing healthcare services.

People and relatives told us staff were caring and trustworthy. Staff shared positive relationships with people and the provider maintained continuity of care. People told us they felt respected and staff treated them with dignity. Staff supported people to remain independent by encouraging them to engage in daily living activities. People’s cultural and religious need were met and recorded in their care plans.

Most people’s care plans were comprehensive and recorded their likes, dislikes and background history. People were supported to remain active and participate in activities for their interests. The management

This inspection took place on 22 March 2016 and was unannounced. The previous inspection on 30 May 2013 found the service met all the standards inspected with the exception of supporting workers. The service was inspected again as focussed inspection with regard to this standard in 2 October 2013 the service met the regulation.

The service is registered to provide accommodation for up to six people who require nursing or personal care. The service is for people who have learning disabilities and autistic spectrum disorders and/or mental health. At the time of inspection there were five people living at the service.

There was a registered manager at the service. 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 that although medicine was administered appropriately medicines were not stored in a safe manner. People using the service told us they felt safe at The Jennifer Home and that they were “well looked after.” We found the provider had systems in place to manage safeguarding matters which helped to ensure people's safety. Care plans addressed the safety risks identified for individuals. The staff team could demonstrate they were knowledgeable about the people living in the service and knew what steps to take to keep people safe.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). We found the management had an understanding of MCA legislation and DoLS but staff and the management team had not received formal training.

People said staff were kind and respectful. We observed staff approached people in a friendly manner and gave people time to express themselves. We saw staff respected people’s privacy by knocking at bedroom doors and they did not enter without permission. Staff kept people’s information in a confidential manner.

Each person had a person-centred plan reviewed on a regular basis. Care planning responded to the diverse needs of the people using the service. The service encouraged people to undertake individual and group activities they enjoyed. People were encouraged to raise concerns and complain if they were not happy with the service they received.

There was evidence of good leadership this included regular auditing of processes such as care records and medicines to ensure the service adhered to the correct procedures. Staff received regular supervision and team meetings.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 12 Safe care and treatment.

You can see what action we told the provider to take at the back of the full version of the report.

This was a follow up inspection as when we visited on 30th May 2013 we could not find strong evidence that staff were receiving an appropriate level of support and training to enable them to keep up-to-date with all aspects of their role. On this visit we found that the provider had made significant improvements to staff training, staff supervision and record keeping.

We took the opportunity to speak to four of the five people who used the service who told us they were really happy living in the home. One person said the manager was like 'their second mum'. Another person said the food was 'brilliant'. Two people told us about some of the social events they had enjoyed attending over the summer, such as a day trip to Southend. Two people went out to attend the local college during our inspection visit. We observed that the people who used the service were very fond of each other and of the staff. We saw that the manager and staff members were very proud of the achievements of people who used the service and their successes, such as giving up smoking or going to college, were warmly praised. When we spoke to a member of local authority staff who had recently visited the home they said they had observed 'good care'.

The home was clean and tidy and a garden make-over had been completed. This included improved access for less mobile people. Two people told us how much they had enjoyed sitting out in the garden over the summer.

People told us they were very happy living in the home. One person said 'I feel content, safe, comfortable.' Representatives of one placing authority told us that the home had 'turned around' the lives of the people they had placed.

We found evidence of good care being delivered in a homely, supportive environment and careful, consistent administration of medication. Staff had a thorough knowledge of people's needs.

However, staff training and record keeping, particularly in relation to the Mental Capacity Act 2005, were given a low priority. This meant that people could not be sure that staff knew what their rights were or would be able to identify what action they needed to take if someone could no longer make their own decisions.

We spoke to and observed all the five people using the service during our inspection. People told us they could talk to the manager and staff and they felt they were involved in decisions about their care. People told us staff provided them with information and support which enabled them to make choices. They told us staff always asked them what they wanted to eat and how they wanted to spend their time.

All the five people we talked to said they were happy living at the home. One person told as that they have lived in the home for seventeen years and that they have always been happy. People using the service appeared relaxed, clean and well dressed.

All the people we talked to told us they had lived in the home for many years and they were well settled in the home. They said they felt the manager and staff provided them with care that met their needs.

We noted people were relaxed and confident when interacting with the staff. People told us that the staff were "pleasant, showed consideration and fairness".

People told us that they could talk to the staff and the manager if they had a concern. They told us that they believed the staff and the manager were approachable. People told us they knew how to make a complaint if they were not happy about anything. A person told us that they did not have any complaints; and they had received "information about how to make a complaint" in a welcome pack.

We found that overall the home provides a good quality of service. People we spoke with told us they were very happy living in the home and that they loved the home. They said the staff were friendly and helpful to them, easily approachable and listened to them.