Care service description

Juniper is a service for up to three people with learning disabilities, that sometimes present with behaviours which could challenge. The service is a detached bungalow in a residential area close to local amenities. There were three people living at the service when we inspected.

Juniper 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. Juniper accommodates three people in one adapted building.

Rating at last inspection

At the last inspection on 4th November 2016, the service was rated Good.

Rating at this inspection

At our inspection on 19 January 2018 we found the service was still Good.

Why the service is rated Good

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 life as any citizen.

People and staff felt safe, safeguarding policies were in place to protect people from harm and abuse. People were supported by a small, consistent staff team, that clearly knew them well. Staff were recruited in line with legislation and best practice. Staff had received training and had regular individual meetings with the registered and deputy manager to ensure they were effective in supporting people. People were encouraged to be as independent as possible in managing their medicines. Risks to people and the environment had been assessed and action taken to reduce the risk where possible. Staff had effective training on infection control and the service was clean, tidy and without odour when we inspected.

People were actively involved in the way the service was run, and were consistently given every opportunity to be as independent as possible. 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 support this practice. People were supported to make decisions about the food they ate, and staff supported people to maintain a balanced diet. People were supported to be as healthy as possible, and had regular reviews with the GP, dentist and the chiropodist. People were involved in the running of the service. People supported staff to redecorate their bedrooms, and in the day to day upkeep of the service.

People and their relatives told us they were treated with kindness and respect. Strong relationships had been formed between people and staff over time. We observed kind interactions between staff and people throughout the inspection.

People were partners in planning their care, which was done in a person centred way. There were no complaints since the previous inspection, and the registered manager had policies in place to ensure all incidents resulted in learning and improvement for the people living there. End of life care was not being delivered at the time of our inspection, but the registered manager had started to discuss wishes with people and their families.

The registered manager had been in post for several years, and understood their regulatory responsibilities. Where necessary they had submitted notifications to the CQC and the rating for the service was clearly displayed. There was a clear vision for promoting independence and a positive culture which people and staff confirmed and feedback was regularly sought. People, staff and healthcare professionals were united in their positive feedback about the registered manager. The registered manager regularly carried out checks and audits to ensure people were provided safe effective care.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records looked at.

If you'd like to see the evidence that supports our summary you can read the full report.

This is a summary of what we found:

Is the service safe?

We saw that people had detailed risk assessments in place to help ensure that they were protected from avoidable harm. Staff we spoke with had a good understanding of people's conditions which enabled them to try and prevent incidents that might cause harm between the people living at Juniper.

Medicines were administered by staff who were appropriately trained to do so. Appropriate checks were carried out before staff began working at the service and one relative told us, "The staff seem to stay a long time". This meant that people experienced consistent care from staff who knew their needs well.

Is the service effective?

Care and treatment for people living at Juniper was designed to enable them to lead a life as full and independent as possible. We saw that people took part in a range of activities and were active members within the community. Upon returning from a day centre one person told us, "I've made some new friends". Another person returned from their paid work in a local pub with their earnings for the week.

Is the service caring?

We saw that staff treated people with kindness, dignity and respect. People were supported and encouraged to make choices and decisions about their care and we saw that this was diplomatically and sensitively handled. One person told us, "I know what's in my plan (of care)". One relative we spoke with told us the care was "absolutely amazing".

Is the service responsive?

We saw that the service was organised to meet people's needs. People had daily routines and weekly plans in place which had been agreed with them. We saw that if people's needs changed, such as one person who needed support with the job they had previously been able to do unaided, the changes were put in place swiftly. There was evidence to suggest that prompt, appropriate action was taken when people's health needs changed.

Is the service well led?

People, relatives and staff we spoke with expressed their satisfaction, in different ways, about the way the service was run. One person told us "I get to choose what I want to do". Although we were unable to see the annual survey results during our visit we saw that regular meetings were held with people and staff. One member of staff told us, "The manager is really lovely. If we have any problems we can go to (them)". We saw that the home was kept clean and records relating to people and staff were well organised and up to date. Regular audits were carried out to ensure that people were cared for safely. One relative told us, "'I'm so impressed with the care they (the manager and staff) provide".

People told us they were happy living at the service. One person told us “The staff are nice to me” and “I like it here. I get to do the things I want everyday”. Another person told us “They take me out places; I go to the bank, shops and out for lunch”. A relative told us that the staff had supported a person to find employment and it had been the “making of him”.

People received care and support that met their needs and promoted their rights. There were systems in place to obtain people’s consent to their care that ensured their rights were upheld.

The environmental concerns identified at our previous inspection on 8 October 2012 and 23 October 2012 had been addressed. There was new carpet and flooring in the communal areas, providing a homely and hygienic environment in which to live.

People were cared for by staff who were supported in their role and received training to be able to undertake their role safely and effectively. One staff member told us that the staff “all support each other”.

There were systems in place to regularly monitor and assess the quality of the service provided and maintain the health and safety of the environment.

This inspection took place on 4 and 5 November 2015 and was unannounced. The previous inspection was carried out in May 2014 and there were no concerns identified.

Juniper is registered to provide accommodation and personal care for up to three people who have a learning disability. At the time of the inspection three people were living at the service, each having their own bedroom. People had access to a communal lounge, dining area, kitchen, laundry room and shared bathrooms. There is a well maintained garden and outside area. There is off street parking within the grounds and access to public transport with a bus stop opposite the service.

The service has an established registered manager, who was present on the days of the inspection visit. 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 and associated Regulations about how the service is run.

Staff told us they felt confident that they could speak to the management of the service if they required support and guidance. A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. We were able to view these documents after they were emailed to the registered manager from the provider. Staff personnel records did not hold a recent photograph of them.

New staff underwent an induction programme. Existing staff supported new recruits who shadowed them on shifts. Staff were supported to carry out their duties effectively and were offered further support through one to one supervision, team meetings and appraisals.

People had in depth personalised care plans, risk assessments and guidance in place to help staff to support them in an individual way. Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. People were supported to pursue individual interests and hobbies. Staff spoke about people in a respectful way which demonstrated they cared about the people’s welfare. People interacted positively with staff, smiling and being involved in conversations.

People were supported to make their own decisions and choices and these were respected by staff. Staff were aware of the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time.

People had family that were important to them and contact was supported by staff. People felt safe in the service and when out with staff. The service had safeguarding procedures in place and staff had received training in these. People had their needs met by sufficient numbers of staff. People received care and support from a small team of staff and the registered manager worked on rota alongside staff at times.People were happy with the service they received and felt staff were kind.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. Safety checks were completed and there were regular fire drills so people knew how to leave the building safely.

People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported to make their own drinks and cook when they wanted to. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

People felt staff were caring, they said they were treated with dignity and respect. Staff knew people and their support needs well. Established members of staff had built up relationships with people and were familiar with their life stories and preferences. People’s individual religious needs were met.

People felt comfortable in complaining, but did not have any concerns. People and their relatives had opportunities to provide feedback about the service both informally and formally.

People felt the service was well-led. The registered manager adopted an open door policy and regularly worked alongside staff. They took action to address any concerns or issues to help ensure the service ran smoothly. Staff felt the registered and deputy manager were supportive of them and the staff team.