This comprehensive inspection took place on 15 and 23 May 2018 and the first day of the inspection was unannounced. We told the provider when we would come back for the second day of inspection.

At the last inspection on 18 May 2016 the service was given an overall rating of Good, with a breach and requires improvement in Effective. The breach was in relation to staff not receiving regular supervisions or annual appraisals. 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 ‘Effective’ to at least good.”

At this inspection on 15 and 23 May 2018 we identified the provider had made improvements to the frequency and support provided in staff members supervisions and annual appraisals. Scheduled supervisions took place when planned and staff were encouraged to participate in the agenda, ensuring areas of interest were discussed during the supervision.

Supervisions were recorded and staff were encouraged to request additional supervision meetings as and when they felt necessary. Although there had been improvements in the frequency of supervisions, we also identified the process was not as person centred as it could be. We raised our concerns with the registered manager on the first day of the inspection. One second day of the inspection, the registered manager provided us with an update of supervision records, which were person-centred and tailored to individual staff members.

Joybrook 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.

Joybrook accommodates up to 15 people in one adapted building. Joybook is a large residential house situated in a quiet road in the London borough of Lambeth. At the time of the inspection there were 14 people using the service.

The service had a registered manager in place. 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.

Staff received training in safeguarding and whistleblowing, which enabled them to identify, report and escalate suspected abuse. Risk management plans identified known risks and gave staff clear guidance on how to mitigate risks in a safe manner. Changes to risk management plans were shared with staff members swiftly.

People’s medicines were managed safely. Medicine records were completed correctly and staff confirmed they received training in medicines management. People continued to be protected against the risk of cross contamination as the provider had robust infection control measures in place.

Staff continued to receive on-going training in all aspects of their roles and responsibilities. People and their relatives felt staff were well trained and could effectively meet their needs. Staff were confident any additional training they wished to undertake would be provided.

People’s consent to care and treatment was sought prior to care being delivered. The registered manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were encouraged and supported to eat sufficient amounts of food and drink to meet their dietary requirements and preferences. People with specific dietary requirements were catered for in corroboration with guidance from healthcare professionals. People described the food as, ‘very nice’, and ‘filling’.

People received care and support from staff that treated them with dignity, respect and supported their diversity. People were encouraged to acknowledge their culture and faith as they wi

Joybrook is a care home for up to 15 older people who require personal care. Some of the people live with dementia. On the day of the inspection, 14 people were using the service.

This unannounced inspection took place on 18 May 2016. We last inspected Joybrook on 5 June 2014. The service did not meet all the requirements we inspected that time. The provider was non-compliant with the regulation of notification of other incidents as required by CQC.

The service has 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 this inspection we found that the provider had breached Regulation 18 (2) (a) of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. The breach of the regulation relates to staffing. The registered manager had not always supported staff in their roles. Although staff told us they were supported by management, they had not received one to one supervisions or annual appraisal to reflect on their practice. You can see what action we have told the provider to take at the back of the full version of this report.

People were safe at the service. The service had assessed and identified risks to people’s health and safety and support plans had sufficient guidance for staff on how to keep people safe. Staff knew the types of abuse and how to recognise and report any concerns they had to protect people from harm. People received the support they required to ensure their took their medicines safely in line with their prescriptions. Medicines were securely and safely stored at the service.

There were sufficient staff on duty to meet people's individual needs and to support them with their interests. The provider ensured suitable staff were recruited through a robust recruitment procedure.

Staff knew and understood how to communicate with people about their choices and preferences. People told us they were happy to be living at Joybrook. Staff had the relevant skills and training which enabled them to plan and deliver people’s support safely and competently.

Staff spent time and were not hurried when they supported people. Staff knew people well and had developed positive relationships with them. The service supported people to maintain relationships with their friends and family. People were treated with dignity and their privacy was respected. People were asked about their views of the service and the care and support they received and their feedback was acted on. The staff team worked effectively to ensure people had a positive experience of the service.

Staff upheld people's rights and supported them in line with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff ensured people who lacked mental capacity were not unlawfully deprived of their liberty.

Staff assessed people’s needs and plans were in place to ensure they received the support they needed. Staff regularly reviewed people's health and the support they required to reflect their current level of needs. Care records were up to date and accurate, so that staff could ensure people received appropriate support. Staff supported and encouraged people to be independent. The registered manager sought people's views and opinions about the service and acted on their feedback.

People enjoyed the nutritious freshly home cooked food provided at the service. People could choose what they wanted to eat. People's cultural needs and personal preferences were met in relation to their diet. Staff engaged people in activities of their choice which reduced the risk of isolation and boredom.

Staff monitored people’s health needs and ensured they accessed the healthcare services they needed. The service in

A single inspector carried out this inspection. The focus of the inspection was to answer our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. If the service identified that someone could have been at risk, for example of having a fall, then they put strategies in place to minimise those risks. Staff were aware of these strategies and acted accordingly.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager told us that no one at the service currently had applications submitted under this system. However, it was possible that the provider may need to submit an application in the future.

We found that, although staff had received training in both mental capacity and safeguarding of vulnerable adults, no specific training had been received in relation to the DoLS and the provider did not currently hold a policy describing the operation of the DoLS. The manager was able to describe under what circumstances it might be appropriate to make a DoLs application and what the process was for doing this.

Is the service effective?

We found that people's needs had been assessed and suitable care plans were in place. These were regularly reviewed. Staff described strategies for obtaining verbal consent prior to providing any personal care. The provider acted in accordance with legal requirements where people did not have the capacity to consent.

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

Is the service caring?

We observed that people were generally relaxed and confident in their interactions with each other and with members of staff. One person told us "I like the people who work here." Another person said "It is pleasant. I do like it here." Someone else using the service told us "I like it. The staff are very kind. This is the best place."

We also spoke with relatives of people who were using the service. One relative told us "Staff are polite and keep me informed." Another person told us they were "pleased so far" with the service provided.

Is the service responsive?

We examined how the service responded to complaints as well as what actions they took. We saw that the service responded promptly to complaints and followed the provider's procedures for addressing complaints. Actions were taken to resolve any problems and these were well documented. More general concerns were raised by people at monthly resident's meetings. These were monitored and responded to.

We looked at responses to any adverse incidents involving people who used the service.The service could show us evidence of how they responded to incidents. We saw that steps were taken to minimise the possibility of any incident recurring.

Is the service well led?

The provider had effective systems to regularly assess and monitor the quality of service that people received. For example, people using the service were invited to attend monthly resident's meetings. Those who did not wish to attend the meetings were invited to make comments to staff members in advance of the meeting. Potential improvements to the service were considered at the meetings. Members of staff were also invited to attend meetings where they could raise any concerns and the quality of care being provided was discussed.

The provider had a system in place to record any adverse incidents which affected the people using the service. There was evidence that learning from incidents took place and appropriate changes were implemented. However, the provider is required to notify the Care Quality Commission about some types of incidents. We found that the provider was not always making these notifications. We have asked the provider to draw up an action plan for how they will identify when these notifications need to be made in the future. We will go back to the service to check that these actions are implemented.

At the time of our visit there were 13 people living at Joybrook, we spoke with four people. People told us that they were happy living at Joybrook. One person told us "I am happy here, I would not want to leave". Another person told us "the staff are very kind".

We found that people were respected and their dignity maintained by staff at Joybrook. We found that staff supported people using the service with their care needs.

The provider had a safeguarding policy and procedures for staff and people using the service. Staff were aware of the signs of abuse and the procedure to follow in response to an allegation of abuse.

The building was appropriate for the needs of people using the service. There was a programme for building repair and redecoration and some of this work was being carried out at the time of the inspection.

The staff we spoke with told us that they enjoyed working at Joybrook.

We spoke with five people using the service, and all expressed satisfaction with their lives in the home and the support that they get from the staff and the managers.

We spoke with the two local authorities who placed people in the home and they told us that the care was good but was not always well documented.

People told us that they like living at the home, and that they can make choices about their daily lives, what they want to do and what they want to eat. They told us the staff are friendly and support them with their needs.

People like the calm and relaxed environment.

People enjoy the food provided by the service and said they are able to choose what they want to eat.

We saw people being treated with respect. However, we do have concerns about a number of areas of the service such as out of date staff training and a lack of appropriate equipment to support people’s needs and ensure they are safe.