Jigsaw Creative Care Limited - 77 Russell Street is a respite care service. It can provide accommodation and personal care for up to three people at any one time. Eight people used the service at different times. On the day of the inspection one person was using the respite service.

At the last inspection the service was rated requires improvement in safe and good in effective, caring, responsive and well-led. The overall rating for the service was good. At this inspection we found the service had made improvements in keeping people safe. The service remained good in all the other domains and therefore the overall rating remains good.

People received safe care from the service. Improvements had been made to maintain the property and garden to a good standard and reduce risks to people’s safety. Robust recruitment procedures were now followed to ensure as far as possible only suitable staff were employed. Risk assessments were completed to enable people to receive care with a minimum of risk to themselves or the care staff. Staff were trained to safeguard and protect people. They understood their responsibility to report concerns.

People continued to receive effective care from staff who had been trained and had the necessary skills to meet people’s needs effectively. Staff were supported through one to one supervisory meetings, annual appraisals and staff meetings. They were able to seek advice when necessary and had opportunities to discuss and review their work. People were supported to have sufficient to eat and drink. When necessary their nutritional needs were monitored and professional advice was sought appropriately. People’s healthcare needs were mostly managed by their families. However, when required staff supported people to attend appointments and/or seek advice.

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. However, we noted these were not recorded in accordance with the Mental Capacity Act (2005) MCA and have made the following recommendation. We recommend that the provider refers to current guidance on recording best interest meetings and decisions in line with the MCA.

The service remained caring. We observed staff were kind and patient when supporting people. People’s privacy and dignity was protected and they were treated with respect. People and their families were involved in making decisions about their care. Staff enabled people to maintain and develop independence as much as they were able to.

The service remained responsive to people’s individual needs. Staff knew people very well and care plans were focused on each individual, their preferences, routines and choices. People had access to varied activities which they enjoyed and engaged in. Activities were designed to suit people’s particular needs and interests. Complaints were investigated and resolved in line with the provider’s policy.

The service continued to be well-led. The registered manager promoted an open, friendly and person centred culture. They led by example, were supportive of the staff team and listened to feedback and views to make improvements. The quality of the service was monitored and regular audits and checks were completed.

Further information is in the detailed findings below.

This inspection took place on 22 July 2015 and was unannounced. Jigsaw Creative Care Limited is a respite care service. It can provide accommodation and personal care for up to three people at any one time. On the day of the inspection one person was using the service.

At the time of the inspection 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.

The provider completed recruitment checks on potential members of staff. However, where gaps in employment history were identified they were not explored or explained. Maintenance of the property was not always carried out promptly and the décor required updating. Checks on fire alarms and emergency lighting had not been completed in accordance with the provider’s policy. These matters were all raised with the registered manager who took immediate action to begin correcting them.

There was a system to ensure people received their medicines appropriately. The quality of the service was monitored by the registered manager through gaining regular feedback from people and their relatives and the auditing of the service. The provider had plans in place to deal with emergencies that may arise.

People who use the service were unable to speak with us but relatives told us they were happy with the service they received from Jigsaw Creative Care Limited and felt their family members were safe using the service. The service had systems in place to manage risks to both people and staff. Staff had good awareness of how to keep people safe by reporting concerns promptly through procedures they understood well. Information and guidance was available for them to use if they had any concerns.

People were treated with kindness, dignity and respect. They were involved in decisions about their care and relatives told us they had been asked for their views on the service. People’s care and support needs were reviewed regularly. The registered manager ensured that up to date information was communicated promptly to staff.

Staff felt well supported by the registered manager and said they were listened to if they raised concerns and action was taken straight away if necessary. We found an open culture in the service and staff were comfortable to approach the registered manager for advice and guidance.

Staff understood their responsibilities in relation to gaining consent before providing support and care, therefore people’s right to make decisions was protected. New staff received an induction and training in mandatory topics. The new Care Certificate award was being introduced and staff including the registered manager had signed up to complete it.

At a previous inspection dated 3 June 2013, we found the provider had not adequately maintained the property or grounds. This meant that staff and people using the service were not protected from the risk of unsafe premises and grounds. The provider sent us an action plan which stated what they would do to achieve compliance and declared they would be compliant by 25 June 2013. At this inspection we found the provider had taken all necessary steps and was now compliant with the regulations.

The manager was not present during our inspection. We toured the home and grounds, and spoke with staff regarding work recently completed at the home. Staff we spoke with told us that the maintenance issues had been resolved quickly after our inspection. We viewed all of the rooms and observed the home had recently been decorated. Staff told us the decoration was a great improvement. Staff we spoke with told us the residents had told them they were happy with the decoration of their bedrooms. Maintenance issues raised at our last inspection had been addressed.

We viewed the garden and observed concerns that we had raised had been addressed and the garden had been well maintained. We noted that an additional hand rail had been installed along the path to the garden. This ensured people were able to access the garden safely.

The home provides respite care currently for nine people and can accommodate three people at one time. When we refer to the manager in this report, we are referring to the Registered Manager Mr Ondieki who was present at the inspection.

At the time of the visit one person was present but left to take part in activities. Most people supported by Jigsaw were limited in their abilities to understand our questions and communicate verbally. We were able to speak later with relatives of people who stayed at the home. We spoke with the local authority and local commissioning team. Relatives we spoke with, the local authority and commissioning team had no concerns about the care and service provided by the home.

We looked at the safety and suitability of the home. On inspection it was evident that parts of the home required redecoration and maintenance. We observed one of the bedrooms had wall paper peeled off and was in need of decoration. We noted maintenance issues raised by staff at the beginning of the year had not been resolved at the time of the inspection.

We noted the home was clean and free from odours. We reviewed the policies for infection control and found these to be up to date and adhered to.

We viewed three recruitments files and found these to contain all the information required.

We viewed the records of the home including care plans, recruitment files, policies and procedures. We found these to be up to date, fit for purpose and securely stored.

At the time of the inspection there were two people staying at the home. People at the home were limited in their abilities to understand our questions and communicate verbally so we observed the care provided to help us to understand their experience. We spoke to five relatives of people using the service to get their views on the care provided.

Everyone we spoke to was complimentary about the service calling it “absolutely excellent”, “top class” and “second to none”. One relative told us "(person) seems really happy”.

We observed staff asking for people’s consent and informing them about their care. One person told us “they treat (person) with respect and keep (person) informed”.

We observed care being delivered in line with people's care plans. One relative told us “I’m happy I’ve found a place that can deal with my son’s needs”.

There were procedures in place to ensure staff administered medicines competently and safely. One relative told us “I send in the meds and they give it to (person), no probs”.

Relatives told us they felt staff were “friendly” and “professional”. One relative told us “I wish they’d go and train other people, they’re very up on everything”. We observed staff interacting with people in a compassionate, competent manner.

There was a clear complaints procedure and we saw examples of staff responding to people’s dissatisfaction and working to resolve the issue, where people were unable to verbally communicate this.

People who use the respite care services of 77 Russell Street were not available to speak to us on the day of our visit. We were told by staff that the people who use the service would be unable to speak with us on the telephone to give us their view of the services provided.

We spoke with relatives of people who use the service who spoke to us on their behalf. They told us that people were treated with respect and that they were involved in the decisions made about their care. They said they had been involved in the review of their relatives care plan and had agreed to any changes made. They told us that they had no concerns or worries about the respite care services provided. They said that they were kept fully informed and could approach staff if they were worried or concerned.