We carried out an unannounced inspection of Jalna Residential Care Home on 2 and 3 May 2018.

Jalna Residential Care Home provides accommodation and personal care for up to a maximum of 22 older people, some of whom are living with dementia. The service does not provide nursing care. At time of the inspection there were 22 people accommodated in the home.

At the last inspection in November 2015 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good. However, we made a recommendation regarding the safe management of people’s medicines.

People received their medicines when they needed them. Staff administering medicines had received training and supervision to do this safely. However, further improvements were needed to ensure people’s medicines were managed safely at all times.

People were happy with the care and support they received. They told us they were happy and did not have any complaints. Staff understood how to protect people from abuse. A safe and robust recruitment procedure was followed and arrangements were in place to make sure staff were trained and competent. People considered there were enough staff to support them and staffing levels were monitored to ensure sufficient staff were available.

The information in people's care plans was sufficiently detailed to ensure they were at the centre of their care and risks to people's health and safety had been identified and managed safely. Relevant health and social care professionals provided advice and support when people's needs changed.

People had 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 respected people's diversity and promoted people's right to be free from discrimination. People's dignity and privacy was respected and upheld and staff encouraged people to be as independent as possible. The home was a clean, safe and comfortable place for people to live in with further improvements planned.

People's nutritional needs were monitored and reviewed and people were given a choice of meals. People had access to a range of appropriate activities. There were effective systems for assessing, monitoring and developing the quality of the service being provided to people. People and their relatives were consulted around their care and support and their views were acted upon.

Further information is in the detailed findings below.

We under took a comprehensive inspection on 12 November 2016. This was an unannounced inspection which meant the provider did not know we were coming.

Jalna Residential Care Home is registered to provide care for up to 22 people. The home was registered with the Commission to provide personal care for older people. At the time of our inspection there were 19 people in receipt of care from the provider.

The registration requirements for the provider stated the home should have a registered manager in place. There was a home manager in post on the day of our inspection and we were aware that the Commission had received a registered manager’s application from them to register. 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 last visited the service on 21, 22 and 23 April 2015 and identified breaches of regulation 12, 13 and 17 of HSCA (RA) Regulations 2014. We asked the provider to send us an action plan which told us when they would be complaint by 3 August 2015. We followed up these actions at this inspection. We also took enforcement action in respect of regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment. We told the provider they had to be complaint with this regulation by 27 July 2015 and followed up these actions at this inspection.

During our inspection we observed part of the lunchtime medication round. We saw that medications were administered in a safe way. We looked at the medications trolley and saw medicines were stored safely and medication administration charts we checked had been completed accurately and fully.

As a result of the last inspection the manager told us they had held a team meeting to discuss the process for reporting safeguarding concerns with all the staff. We were told staff had undertaken training in safeguarding and staff we spoke with was able to discuss the actions to take to deal with allegations of abuse. People we spoke with told us they felt safe in the home.

The manager told us they had introduced a new computer system to complete risk assessments, we saw evidence of risk assessments in place.

As a result of our last inspection the provider had implemented the use of a master key for people’s bedrooms. This would ensure staff had access to people’s bedrooms in the event of an emergency.

People we spoke with told us they enjoyed the choices of meals on offer. We sampled the lunch time meal, there were two choices available for people and included two courses. We saw that there were enough supplies of fresh and frozen food available in the home.

During our inspection we undertook a tour of the building. We checked people’s bedrooms and saw evidence of personal mementoes in them. We spoke with the manager about the temperature in one of the bedrooms as it was cooler than others. We were told windows were opened and radiators were switched off when people went to the main lounge and then put back on before people went back to their rooms. We monitored this room during or inspection and noted the temperature increased when the radiator was switched on.

We saw staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), records indicated saw staff had undertaken recent training in DoLS and dementia.

Staff were observed engaging in positive and meaningful relationships with people who used the service. It was clear that staff had knowledge of people’s individual needs and preferences and assisted people in and timely manner. People who used the service told us staff were kind and caring and gave positive feedback about the home, the staff and the delivery of care they received.

We saw that the provider investigated complaints. Records

During our Inspection of the service in April 2014 we looked at the complaints file and saw that no complaints had been recorded. However we spoke with the relatives of people living in the home who told us of previous complaints. A person living in the home also identified concerns to us that had been brought to the attention of the staff. Their concerns had not been reported to the registered manager and none of the issues had been recorded. This meant we were unclear what action had been taken to address the people's concerns.

Following our inspection the registered manager wrote to us and told us that they would review the way complaints and concerns were managed.

We spoke with four people who used the service and they told us they were happy with the support they received and the way staff responded to them. People told us:

"All the girls are lovely and look after me".

"They are quiet and patient with me and very caring."

"I would feel quite sure that if I was unhappy with anything the staff would do their best to put it right."

We met with the providers who showed us the newly introduced complaints recoding form and we confirmed with them that a new complaints procedure had been introduced, a copy of which was seen in the reception area of the home. We informed that the new procedure had also been placed in each bedroom.

During this inspection we found that all areas of non compliance identified at the previous inspection had been addressed.

You can see our judgements on the front page of this report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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 a summary of what we found:

Is the service safe?

Staff had received appropriate training to care for people living in the home. They had access to policies and procedure for safeguarding vulnerable adults. Some of the staff we spoke with were able to discuss appropriate steps if there were concerns about a person’s mental capacity.(The Mental Capacity Act provides a legal framework to protect people who need to be deprived of their liberty for their own safety). The manager told us there had been no applications made under the Act to deprive people of their liberty.

There were enough appropriately skilled staff in place to care for the needs of people who used the service. We saw the manager monitored staffing numbers and a needs analysis was carried out regularly to ensure staffing ratios were adequate.

Is the service caring?

We observed staff were kind and caring towards the people who used the service. There was a relaxed and friendly interaction between them. There was evidence of staff carrying out care and activities with people and we observed people being spoken to in respectful and kind manner.

We spoke with people living in the home and asked them if staff sat and chatted with them. We were told they were, ‘Too busy’ or, ‘Didn’t have time’. However all people spoken with were complementary about the care they received. Examples of comments received were, “I am happy with the care, I can’t really grumble the owners make sure everything is right”.

We looked around the home and in some people’s bedrooms. We noted people’s bedrooms contained personal items and mementoes. There was a homely atmosphere and we saw there were books and magazines in the small lounge for people to use.

Staff had received training to meet the needs of people who used the service including handling medication, moving and handling, health and safety and first aid. We were told there was an ongoing training programme in place and we saw evidence of plans for future updates including safeguarding.

The care files we looked at detailed the person’s care needs, likes and dislikes and we saw evidence of regular review.

Is the service responsive?

We saw evidence of completed satisfaction questionnaires by people living in the home. There was evidence of complementary feedback.

We looked at the complaints file and saw that no complaints had been recorded. However we spoke with the relatives of people living in the home who told us of previous complaints. A person living in the home also identified concerns that had been brought to attention of the staff. However, their concerns had not been reported to the manager and none of the issues had been recorded. This meant we were unclear what action had been taken to address the people’s concerns. We have asked the provider to provide us with a response on how these complaints will be dealt with.

Is the service effective?

We saw evidence that people who used the service were involved in decisions about the planning and delivery of their care. Whilst people could not recall discussing their care needs, we noted they had signed their care plans to indicate their participation and agreement. .

We saw evidence of people’s health being monitored and appropriate intervention by professionals such as the district nurse of the GP.

We looked at menu choices for people living in the home and saw choice and variety were available. There were adequate supplies of food in the home and we saw evidence staff documented dietary intake.. Staff spoken with were able to discuss appropriate procedures in place to deal with any concerns in relation to dietary needs.

There was evidence of some activities taking place and we observed an activity on the day of our inspection. People had recorded they liked the activities in completed quality audits.

We observed there were some areas of the home cooler than the main lounge areas. We asked the manger about this who told us during the day staff opened bedroom windows and turned the radiators down. We were told if people wanted to return to their rooms staff would ensure the room was warm prior to them returning. We spoke with one person sitting in their bedroom at the time of our inspection who confirmed their room was always warm. We noted the bedroom was a comfortable temperature and the radiator was on.

Is the service well led?

There were systems in place to regularly assess and monitor the quality of the service.

The manager is registered with the Care Quality Commission and takes responsibility for the home. We were told the owners were closely involved in the home and provided excellent support to the manager. Some of the staff spoken with were positive about the support they received from the manager and we saw evidence of positive feedback to staff about effective care from the providers. However some other staff told us the manager was unsupportive.

There was evidence of supervision taking place however we noted the records were brief and lacked details of the action, outcomes and opportunities for staff.

We spoke with six people who lived at Jalna who commented they were happy with the support they received in the home. They told us, “I like living here”, ”They are good pals they help me out” and “Staff look after me well”.

We reviewed the care files of four people who lived in Jalna. We saw that care plans identified the needs of the person and included some information on how they wished their care to be delivered.

We found that arrangements had been implemented to safeguard people’s finances and policies and procedures had been updated.

We spoke with three members of staff who told us they felt supported and confident in carrying out their responsibilities. We saw evidence there were sufficient, suitably qualified staff on duty during our visit.

We found that there were systems in place to monitor the quality of the service being provided.

During this inspection, we spoke with three people individually who lived at the home and all told us they were mostly satisfied with the service they received. One person said, "The staff speak to us in a nice way” and another person commented, “It is a happy home and the staff are ok”.

People told us they had a good relationship with most of the staff at the home and the home was very clean. However people told us they were not always involved or consulted with about their care and treatment whilst living at Jalna. People also told us they had not had a resident meeting for some time and one person told us, “It would be a good idea to have regular meetings to air our views”.

We found that suitable arrangements had not been implemented to manage people’s finances.

Appropriate arrangements had been made to ensure people were protected from the unsafe management of medication, however regular checks and audits had not been put in place.

We found that some checks had been put in place to monitor the care and treatment provided and risk assessments had been completed. Effective systems had not been implemented to regularly monitor, assess and review the quality of service that people received.

This inspection took place on 21, 22 and 23 April 2015 and was an unannounced inspection which meant the provider and staff did not know we were coming.

The home is registered to provide care for up to 22 people. At the time of our visit there were 17 people living in the home. The home was providing personal care for older people including people living with dementia.

The registration requirements for the provider stated the home should have a registered manager in place. There was no registered manager in post on the day of our inspection. The Care Quality Commission has however received an application from the home manager to register. 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 last inspected Jalna on the 23 September 2014 to check whether requirements relating to dealing with complaints had been met. We found action had been taken.

We asked people who used the service if they felt safe in the home and if they had any cause to be concerned about how they were treated. People told us they felt safe. They said, “There is no bullying and the staff are kind and respectful.” However one person said, “I get shouted at, that’s the normal thing.” One relative told us, “The staff are excellent here. They are very professional in all they do. I visit regularly and I have never seen anything that would give me cause for concern.”

We were concerned over the risk of bedroom locks being used when staff were not issued with master keys. This meant staff could not enter people’s bedrooms easily in an emergency situation. People were not given information that explained the safety characteristics of the type of lock in use, and were actively discouraged to hold a key. You can see what action we told the provider to take at the back of the full version of the report

We found individual risks had been identified and recorded in people’s care plans. However the level of risk was based on an overall calculation and review of risk was not always completed. Two incidents recorded regarding behaviour that challenged were not identified as a risk or referred as a safeguard issue. This placed people at increased risk of not receiving the right care and support. You can see what action we told the provider to take at the back of the full version of the report.

People we spoke with told us they had their medicine when they needed it. We found medicines were managed well and appropriate arrangements were in place in relation to the safe storage, receipt, administration and disposal of medicines.

We found the premises to be clean and hygienic. We observed staff wore protective clothing such as gloves and aprons. Soap and sanitizer dispensers to minimise cross infection were installed throughout the home.

We found individual risks had been identified and recorded in people’s care plans. However we found records used to support staff to monitor risks such as nutrition were not being completed properly. This placed people at increased risk of not receiving the right care and support. You can see what action we told the provider to take at the back of the full version of the report.

People were cared for by staff that had been recruited safely and were both trained and receiving training to support them in their duties. We heard some positive comments about the staff and we observed staff were respectful to people and treated them with kindness in their day to day care. We also heard two comments that gave us some concern regarding how staff spoke to people. You can see what action we told the provider to take at the back of the full version of the report.

Each person had an individual care plan. Staff discussed people’s needs on a daily basis and people were given additional support when they required this. Referrals had been made to the relevant health professionals for advice and support when people’s needs had changed.

People we spoke with had mixed views about the staffing levels and availability of staff. We found care staff covered catering duties which meant the number of staff available to attend to personal care needs was reduced during this time. We have recommended this be reviewed.

There were informal and formal systems to assess and monitor the quality of the service which would help identify any improvements needed and provide an opportunity for people to express their views. However these were not entirely effective in raising standards as people had identified areas in need of improvement such as temperature of the home and food.

We also found that monitoring the quality of service delivery such as auditing care plans, risk assessments, and the environment was not completed. Systems to assess, monitor and manage risk relating to the health, safety and welfare of people were not effective. You can see what action we told the provider to take at the back of the full version of the report.

We saw that records relating to people’s care were available in the upstairs office which was frequently unmanned and the filing cabinet was left open. We have made a recommendation to ensure confidentiality of information is maintained at all times.

Staff told us they were confident to take action if they witnessed or suspected any abusive or neglectful practice and had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted an appropriate DoLS application had been made to ensure people were safe and their best interests were considered. Staff were aware of people’s ability to make decisions for themselves and knew the principles of having best interest decisions made to support and protect people.

Staff were made aware of people’s dietary preferences and of any risks associated with their nutritional needs. We saw appropriate professional advice and support had been sought when needed. People’s weight was generally checked at regular intervals and people were given one to one support when this was required. However we have made a recommendation about meeting nutritional needs and monitoring people’s weight.

People’s bedrooms had been nicely decorated and had evidence of personal items and mementoes in them. We found bedrooms and some areas in the home were cold and people using the service had been given blankets to use when sat in their chairs. We have made a recommendation regarding maintaining a comfortable temperature in the home.

End of life wishes was not always documented to give people the opportunity to discuss and document their wishes regarding end of life care. The manager assured us this was being dealt with.

Activities provided were good and included entertainers visiting the home and the usual festive and birthday celebrations. Visiting arrangements were good and visitors told us they were made to feel welcome.

There was a complaints procedure. This was displayed for all to see together with other useful information such as how to contact the advocacy service. People were encouraged to discuss any concerns during meetings, during day to day discussions with staff and management and also as part of the annual survey to give feedback on the service provided.

People told us the management of the service was good. The manager was relatively new and had applied to be registered as a registered manager with CQC. Staff commented, “The manager is lovely. We can always talk to her. She is very approachable.” Staff told us the providers were very good with supporting them and were always in the home. Some accountability for staff performance was evident with spot checks by the manager. However formal supervision was seen to be a reactive response when concerns had been raised about staff conduct and failure to deliver acceptable standards of care.

Where we have identified a breach of regulation during inspection which is more serious, we will make sure action is taken. We will report on any action when it is complete.