Jasmine Court Nursing Home

Jasmine Court provides accommodation, nursing and personal care for up to 66 adults with needs relating to dementia, physical disabilities, and mental health. It specialises in the care of people with complex needs. The service is divided into six separate units over three floors. At the time of our inspection visit there were 47 people using the service.

People’s experience of using this service and what we found

The service was well-staffed, and people received prompt, quality care. Relatives said the staff were patient and understood their family members. A relative told us, “[Person] is happy and the staff have been doing an incredible job looking after them during the COVID-19 pandemic.”

Staff cared for people safely. They understood people’s needs and how to protect them from harm. The premises were cleaned to a high standard and the provider had good infection control systems in place to protect people, visitors and staff.

Some improvements were needed to the way medicines were managed at the service. We have made a recommendation to the provider about this.

The service provided residential and nursing care and people’s healthcare needs were met. A relative said, “The two nurses I deal with are both outstanding human beings and whenever I’ve raised a concern, they’ve been on to it straight away.”

People were supported to have maximum choice and control of their lives and staff supported support them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

Relatives said their family members had improved mentally and physically since coming to the service. A relative told us, “[Person] seems to have come to life since coming from a previous home. The staff are all amazing. I would recommend this home to anyone.”

The registered manager led the service with kindness and compassion and knew all the people using the service well. A visiting healthcare professional said, “The management are very knowledgeable and person-centred. They are caring towards residents and families and they’re well organised.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 May 2019) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Jasmine Court on our website at www.cqc.org.uk

People’s experience of using this service:

Appropriate numbers of staff had not been suitably deployed to meet people’s needs in a safe or timely manner.

The risks associated with people’s care and support had been assessed, though guidance within people’s risk assessments and plans of care had not always been followed.

People were not always provided with their medicines in a timely manner. Medicine management was not always robust.

The providers safeguarding processes for the recording and reporting of unexplained bruising had not always been followed.

Systems in place to monitor the quality and safety of the service being provided were not always effective.

Best interest decisions were not always made by the appropriate people.

People were involved in making decisions about their care and support whenever possible and their consent was always obtained.

The staff team were aware of their responsibilities for keeping people safe from abuse and avoidable harm and had received training in the safeguarding of adults.

People told us they felt safe living at the service. They told us the staff team were kind and caring and they treated them in a considerate and respectful manner. Observations made during our visit showed people were not always treated in a dignified way.

People’s needs had been assessed prior to them moving into the service and they had access to relevant healthcare services.

People's food and drink requirements had been assessed and records kept for people assessed as being at risk of not getting the food and drinks they needed to keep them well were up to date.

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.

The necessary protective personal equipment was available, and the staff team had received training in infection control.

There were arrangements in place to make sure action was taken and lessons learned when things went wrong to improve the service provided.

Appropriate checks had been carried out on new members of staff to make sure they were suitable to work at the service, and training and support had been provided.

People were provided with a comfortable and homely place to live.

People were involved in how the service was run through meetings, the use of surveys and day to day conversations with the registered manager and the staff team.

The staff team had received training on end of life care to enable them to support people at the end of their life with dignity and compassion.

A formal complaints process was in place. People knew who to talk too should they have a concern about their care or support and the registered manager made sure complaints were handled appropriately.

Relatives and friends were encouraged to visit, and they told us the staff team made them welcome at all times.

The registered manager and management team worked in partnership with other agencies, so people received care and support that was consistent with their assessed needs.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

More information is in the detailed findings below.

Rating at last inspection: Good (report published 13 December 2016) all the key questions were rated Good except for safe which was rated requires improvement, and the service was rated as Good overall.

Rating at this inspection: We found evidence to demonstrate and support the overall rating of Requires Improvement.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service provided nursing care for up to 66 older people living with dementia and similar health conditions. At the time of our inspection there were 52 people using the service. Most of the people that used the service had advanced levels of dementia.

The service had 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.

People felt safe living at Jasmine Court. The provider had systems in place for reporting and investigating accidents and incidents. Staff understood what may constitute abuse or avoidable harm to people. They were aware of and practiced the provider’s protocols of reporting incidents of concern.

Risks assessments were in place to manage risks associated with people’s care and support. We saw that these were regularly reviewed and control measures put in place to protect people’s health and welfare.

There were enough staff to meet people’s needs; however, staff were not effectively deployed at meal times. People that used the service, their relatives and the staff that supported them told us that there were enough staff but expressed concerns that the staffing levels about their availability at meal times.

People were supported to have their medicines. Trained nurses supported them with this task. Guidance was not always available or followed to support people who received their medicines covertly or on an ‘as required’ basis.

The provider had an infection control policy. Staff did not always follow this policy.

Staff had access to an effective training and mentoring programme to support them to gain the skills they required to fulfil their role. They received regular guidance from senior staff. They told us that they felt adequately supported in their role.

People’s liberty was not deprived unlawfully. This was because the provider had made applications to the local authority for DoLS authorisation for people that required this. The staff we spoke with demonstrated a good understanding of Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People received the support that they required to eat and drink. People received the support that they required to meet their health needs. They had prompt access to healthcare services when they needed them.

A public address system was used to pass information to staff. We found this to be loud and startling and did not meet the needs of people living with dementia or similar conditions. The registered manager who told us that they would take action for staff to minimize the use of the system and would look into alternative ways they could disseminate information to staff.

Staff were kind and compassionate to people. Staff that we spoke with demonstrated an interest in the people that used the service and this showed that people mattered to them. People were treated with dignity and respect. Staff provided the support that people needed to be involved in decisions about their care by giving them choices.

People’s care plans were comprehensive. Their relatives were involved in planning their care and support.

We received mixed responses about the support people received to engage in meaningful activities. People had access to activities and sensory equipment. The registered manager sent us their action plan which identified that they will develop a wider range of activities to encourage more engagement and stimulation. They said they would do this by December 2016.

People had opportunities to provide feedback about the service they received. They told us that registered manager and staff dealt with any concerns promptly.

The service was led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009. People and their relative felt that the home was well-managed. Staff felt supported by the registered manager to meet the standard expected of them. The registered manager and deputy manager were approachable and accessible to staff and people.

The provider had systems in place to monitor the quality of the service and drive continuous improvement.

You can read a summary of our findings from both inspections below.

Comprehensive inspection of 3 and 4 November 2014.

This inspection was unannounced. At our inspection on 17 June 2014 we asked the provider to take action to make improvements. We asked them to improve practices in relation to people’s consent to care and treatment, people’s care and welfare needs, cleanliness and infection control, staffing levels, supporting staff and the systems for assessing and monitoring the quality of the service. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. We found that this action had been completed in our inspection on 3 and 4 November 2014.

People who used the service including relatives we spoke with, made positive comments about the care and treatment provided. We saw staff treated people with dignity and respect and involved them as fully as possible in decisions.

People were supported by staff who had received training on how to protect people from abuse. Safeguarding procedures were in place and appropriate action was taken if concerns were identified. Risk assessments had been completed where appropriate for people who used the service, staff, visitors and the environment. People received their medicines safely and as prescribed by their doctor.

There were sufficient numbers of staff available to meet people’s needs and keep people safe. Staff had the right skills and experience and received an initial induction and on-going training and support. Recruitment practices were safe and relevant checks had been completed before staff commenced work.

People’s human rights were protected because staff were aware of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. This is legislation that sets out the requirements that ensures where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. The home made appropriate and timely referrals to health care professionals and recommendations were followed. Support was also provided for people to attend routine health checks.

People told us that they felt included in discussions and decisions about their care and treatment. Information was available that advised people about independent advocacy services and information about the service including the providers’ complaints procedure. The service provided personalised care and treatment, people had been asked what was important to them in how they wished to be cared for. This information was reflected in their plans of care.

People who used the service, relatives and staff were positive about the leadership and said improvements had been made to the service. The registered manager regularly assessed and monitored the quality of care by completing audits and seeking feedback from people who used the service.

18 February 2016 Focused Inspection into Concerns

Following our inspection of 3 and 4 November 2016, we undertook a focused inspection after receiving information of concern about the service. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

The inspection took place on 18 February 2016 and looked into concerns about people’s needs not being met due to low staffing levels. On the day of our visit, they were 60 people using the service. Most people in the three floors required nursing care, and had high dependency levels with their general health including mobility, mental health and communication needs. During the visit, we found that:

Staff were knowledgeable of what would constitute abuse to people. However, they did not feel always confident to report these issues.

The service did not have sufficient numbers of staff to meet people’s needs safely or promptly. People did not have always have access to equipment that met their needs in a safe manner.

Staff did not receive supervision support from their manager. Staff did not understand the relevance of Mental Capacity Act (2005) to their role.

People did not receive the support they required to meet their nutritional needs in a timely manner.

People had prompt access to health care professionals.

People did not receive care that was personalised and reflected their individual needs and preferences.

The service provided opportunities for people to make complaints.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we spoke with the acting manager, senior manager and five staff. We looked at some of the records held in the service, including the care files for six people who used the service.

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. This is a summary of what we found.

Is the service safe?

Whilst we found the environment in the main clean and hygienic, we identified concerns with the cleanliness of the six kitchens on each of the three floors. These were used to serve people's meals and provide drinks and snacks.

People had their dependency needs assessed which informed the level of staff required, to meet people's needs and keep people safe. We found concerns with the staffing levels provided. The staffing levels provided were not sufficient in keeping people safe, meeting individual needs and promoting people's well-being.

We, the Care Quality Commission (CQC) monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This means that when people have their liberty deprived in order to keep them safe, this was only done following a best interest assessment carried out by the local authority DoLS team. We saw some people had authorisations in place. This showed the provider had acted appropriately and within the legislation.

Is the service effective?

We saw staff communicated with people to gain their consent to care delivery, and used a best interest decision approach. However, we found the provider had not correctly followed the Mental Capacity Act legislation. This meant the provider had not completed the formal process to assess a person's capacity to consent to a specific decision.

Care records showed that whilst people's life history, routines, hobbies and interests were recorded, this information was not used to develop a person centred approach to care delivery. Whilst staff were able to demonstrate an understanding of people's care needs, they did not know about people's life and social histories.

Whilst staff received appropriate training opportunities, the systems in place to support staff were limited. Staff told us they were satisfied with the training opportunities available to them, but said that they had not received an opportunity to meet with their line manager to discuss their training and development needs. Records looked at confirmed what staff had told us.

Is the service responsive?

The provider had a complaints policy and procedure that supported people to know their rights, and what action to take should they wish to complain about the service. However, relatives we spoke with told us they were not aware of what the procedure was to make a complaint.

We saw that some parts of the environment had been enriched with dementia specific items. For example there was a vintage set of bedroom furniture on one of the corridors, and a seaside theme on another. This provided an opportunity for reminiscence based activities. However, we did not see that people who used the service were supported to explore these environments. Whilst the service had an activity coordinator and we saw records that showed some activities were provided, meaningful activities and stimulation was limited. The lack of activities was a reoccurring concern that relatives had about the service.

Is the service caring?

We found staff were on the whole kind and attentive towards the people they cared for. However, we found the staff lacked direction. The interactions with people were when care delivery was provided. Some people were cared for in bed, we did not see staff provide any social interaction. We saw that some people had additional needs and were supported by a designated member of staff. We found that the one to one time was not used as effectively as it could have been. For example, staff did not use this time to support the person to engage in a meaningful activity.

Is the service well-led?

Staff were aware of their roles and responsibilities. Some staff raised concerns about the leadership and that they did not feel valued or listened to.

We found that the acting manager and senior manager had limited decision making ability. For example, the acting manager told us that the occupancy numbers had increased to full capacity, however the staffing levels had not increased to reflect this. They said a request had been made to increase the staffing levels but a decision had not been made.

We saw the provider had quality assurance processes in place. However, these systems had failed to identify some of the concerns we found. Where the provider was aware of issues and concerns, appropriate action had not been taken in a timely manner to reduce risks to ensure people received an effective and safe service.

People told us that they felt safe being supported by the staff. All staff had received safeguarding training and understood the types of concern that may present a risk to the vulnerable people they supported. Staff were well supported, which helped to ensure that people who used the service had their needs met reliably.

People using the service and the relatives of people who used the service told us that staffing numbers had improved. They told us staff on duty responded to their needs and requests in a timely manner. One person said, 'I now go out into town with a carer more often.' Staff also told us that they were able to safely support people and spend time doing meaningful activities to promote their wellbeing.

People knew how to make a complaint and were confident to do so. Visiting relatives also told us that they were confident to raise concerns or make a complaint. One relative said, 'I have absolutely no concerns. Any little problems that we as a family have raised with the manager, has been addressed quickly.' We found that complaints were all investigated in a timely manner in line with the provider's complaints procedure and where possible, to the complainant's satisfaction.

People received care and support from staff in a manner that was safe and appropriate. Staff helped to maintain people's dignity; their rights and choices were respected. People's care needs were assessed and care was planned and delivered in accordance with their care plan. One person told us they were helped every day to get ready and said: 'I'm going into town with '.. [staff]'. Records showed people's needs were met and their health and wellbeing was monitored. People had access to health care support and records showed that doctors and specialist nurses visited people when required.

Relatives told us they were satisfied with the care and support their family members received. One relative said: 'We're happy with the care he gets. I know sometimes, he has to wait for a bit longer because staff are busy, but they know what he's like.'

We received concerns about the staffing levels and found that the staffing levels were not consistently maintained. Staff we spoke with were committed to looking after people using the service but often felt they were rushed because there was not enough staff on duty. The system in place to source extra staff at short notice was not effective and had the potential of putting people's health and safety at risk.

We observed people using the service who were unable to talk to us. We found staff provided person centred care and support, and maintained people's dignity at all times.

There were menus now available in formats that were suitable for people to understand. People said they had a choice of meals that met their needs and promoted their health. Individual dietary requirements were met and the meals provided looked balanced and nutritious. People were supported to eat and drink independently because suitable aids and cutlery was provided. Staff supported people to eat and drink in a sensitive manner and maintained their dignity.

The provider had taken steps to ensure there were sufficient numbers of qualified, skilled and experienced staff were employed. People told us they were supported by staff that understood their needs and promoted their safety and welfare.

People's care records, risk assessments and monitoring reports were sufficiently detailed, kept up to date and stored securely. Staff were aware of their responsibilities to maintain confidentiality and accurate records.

People using the service had their care needs assessed and care was planned and delivered in accordance with their care plan. There were a range of assessments and reviews in place that ensured people's health, safety and wellbeing was monitored. People had access to health care support. One person said: 'I'm able to see the doctor and the nurse here, which is better for me.' Although people were provided with sufficient amounts to eat and drink, their individual needs were not always taken into account to enable them to eat and drink safely and with dignity.

People who used the service, relatives and staff expressed concerns about the staffing levels. Staffing levels were not consistently maintained and placed people using the service at risk.

People's care plans and medical records were kept up to date. However, the monitoring records kept in people's bedrooms were not always kept secure.

People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people's health and care needs were monitored and reviewed regularly. Medicines prescribed and were administered safely. There were arrangements in place to support people safely and to deal with foreseeable emergencies.

People's health and care needs were met by qualified nurses and care staff. Staffing levels and skill mix of staff ensured the care needs of people were met safely. Qualified nurses maintained their nurse's registration to ensure people's health needs and medicines were administered safely.