Date of assessment 18 April 2024 to 11 June 2024. This assessment was prompted by concerns about the culture, people’s ability to have choice and control and the overarching governance of the service. We assessed 10 quality statements and 31 corresponding evidence categories in the safe, effective and well led key questions and found areas of concern and area of good practice. The scores for these areas have been combined with scores based on the rating from the last inspection. We met and spoke with people, their loved ones, staff, the provider and local authorities. We visited 5 locations and went to the provider’s head office. Feedback we received was mixed, some people had a good experience and others not so good. Though our assessment indicated areas of concern since the last inspection, our rating overall remains good. We assessed the service against our Statutory guidance ‘Right support, right care, right culture.’ We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
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Jigsaw Creative Care Limited achieved an overall Good rating at its June 2019 inspection, with strong person-centred care, safe medicines management, and improved quality assurance systems following serious safeguarding concerns in February 2019. Well-led was rated Requires Improvement due to inconsistent staff culture, some staff not feeling supported by management, prior failures to notify CQC of abuse allegations, and the absence of an EDHR policy.
Concerns (8)
criticalSafeguarding: “Previously we had concerns that the provider had failed to notify the CQC of some allegations of abuse.”
moderateGovernance: “The service did not have an Equality Diversity and Human Right (EDHR) policy in place.”
moderateLeadership: “Some staff reported to us that they did not always feel listened to, and that they turned to colleagues for support rather than their managers.”
moderateCommunication with families: “Some health and social care professionals told us that they felt improvement was needed in terms of communication and collaboration between themselves and the provider.”
minorStaff training: “Some health and social care professionals told us that they felt care staff would benefit from more specialised training such as autism training.”
minorRecord keeping: “There were proactive 'as required' (PRN) medicines pathway in place...however, these records were not dated.”
minorPerson-centred care: “We could not see from this documentation how people had been involved in developing their care and support plans.”
minorCultural competency: “We have made a recommendation about ensuring people's Equality, Diversity and Human Rights (EDHR) have been explored and documented.”
Strengths
· People felt safe and risks were assessed with Positive Behaviour Support Plans in place; safeguarding concerns were handled appropriately in collaboration with relevant bodies.
· Medicines management was organised and people received medicines on time; errors were identified promptly and learning was embedded.
· Safe recruitment procedures were strengthened following February 2019 concerns, with sufficient staffing levels to meet people's needs.
· Care staff knew people well and provided person-centred, compassionate support; relatives were highly positive about the quality of care.
· People were supported to pursue varied activities and interests, maintaining social connections and living fulfilled lives.
Quality-Statement breakdown (21)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Working in partnership with othersGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsRequires improvement
Jigsaw Creative Care Limited received a Good rating across all five key questions at its first inspection at its current location, demonstrating strong person-centred care, robust safeguarding and governance systems, and effective support for people with learning disabilities and autism in supported living settings. The only notable concerns were staffing levels reported by some staff as stretched, and a minor medicines incident linked to a best interest decision that the service was actively seeking to review.
Concerns (2)
moderateStaffing levels: “We need more staff. There is just enough bodies to cover the rotas. If someone is ill or on holiday everyone else has to do extra hours.”
minorMedication management: “The service had queried the appropriateness and risks of this without success, and it was subsequently a factor in a medicines incident.”
Strengths
· People and relatives consistently reported feeling safe and well cared for, with staff described as kind, gentle and person-centred.
· Robust staff recruitment system including criminal record checks, full employment history, references, and involvement of people supported in interviews.
· Comprehensive induction programme including Care Certificate framework, 20+ hours shadowing, and competency observations before unsupported working.
· Effective safeguarding systems with two designated safeguarding champions and appropriate cooperation with external agencies.
· Detailed individual risk assessments minimising restriction while managing risk, including personal emergency evacuation plans.