Jubilee House

Jubilee House nursing home provides nursing care and accommodation for up to 48 people some who have physical needs and are living with dementia. On the day of our inspection 35 people were receiving care and support at Jubilee House.

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

Staff and the management team took exceptional steps to ensure that people and their families were at the centre of the delivery of care. People were treated as individuals whose life and experiences were considered and factored into care planning. The registered manager and staff went out of their way to ensure that people and their relatives were comforted and looked after in a kind and compassionate manner and treated with dignity and respect. Staff made efforts to exceed people’s care by paying close attention to their needs. People and relatives were at the centre of decision making about their care. Families and friends were considered an essential part of the care team.

Staff at the service went the extra mile to find out what people had done in the past and looked at ways to accommodate activities that were important to people. There were a range of activities available within the service and outside. Staff ensured that people’s lives that were near to the end were provided with care and compassion and that people’s last wishes were provided where possible.

The service had a strong, visible person-centred culture and was exceptional at helping people to live their lives to the fullest. People, their relatives and staff told us the registered manager and the senior staff were supportive, valued their input and ensured that they were included in any changes to the service provision. The registered manager and senior management took a personal interest in people and knew them well. The registered manager worked in partnership with people's families and outside organisations to improve the care and support people received. The registered manager had systems in place which monitored health and safety and the quality of people's support. The systems were responsive and had led to changes being made. The management team was proactive with regard to how people's support could be improved.

Rating at last inspection

At the last inspection the service was rated Good (the report was published on the 8 September 2017).

Why we inspected

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

The inspection took place on 7 June 2017 and was unannounced. There were 37 people using the service at the time of our inspection.

The registered manager was present during our inspection. 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 registered manager had been in post since November 2015.

We previously carried out an unannounced comprehensive inspection of this service on 4 April 2016. At that inspection the service was rated Requires Improvement and 4 recommendations were made to encourage improvements to the way the service was delivered. Immediately following that inspection, the provider sent us an action plan which identified the steps they had taken and would continue to take to ensure improvements were made. This inspection found that the provider had not only done the things they told us they had, but also continued to develop and improve the service to not only meet the fundamental standards, but in some areas exceed them too.

Jubilee House was well-led with good systems in place to provide support that was safe, effective, caring and responsive. Management and staff consistently went the extra mile to ensure people led meaningful and fulfilling lives.

Staff treated people with kindness and took steps to promote their privacy and dignity at all times. Support was provided with compassion and wherever possible people’s independence was promoted.

End of life care was exceptional with the service consistently planning for and meeting people’s final wishes and ensuring their final days were lived comfortably surrounded by the people who knew and cared for them.

People were cared for by staff who were well trained and knowledgeable to meet their individual needs. Appropriate checks were undertaken when recruiting new staff to ensure only suitable staff were employed.

The service had good systems to identify and manage risks to people and to maintain the safety of the service as a whole. People were protected from the risk of abuse or avoidable harm, because staff understood their role in safeguarding them.

Wherever possible, staff supported people to make decisions for themselves. In situations, where this was not possible, appropriate processes had been followed to ensure any decision made was within their best interests and that care was provided in the least restrictive way.

Staff worked in partnership with other health care professionals to help keep people healthy and well. There were good systems in place to ensure people received their medicines as prescribed.

The registered manager had taken proactive steps to ensure people received appropriate nutrition and hydration. Mealtimes were a sociable occasion and people had a plentiful supply of good quality meals.

Each person was appropriately assessed and had an individualised plan of care which outlined how their needs would be met. People were involved at each stage of planning their care to ensure staff provided support in a way that met their needs, preferences and expectations.

People had control over their lives and spent their time as they wished. The service offered a wide range of both group and individual activities that were meaningful to them and which had a positive impact on their lives. Visiting was unrestricted and people’s relatives felt included in the care of their loved ones.

The leadership team had fostered a positive and open culture where people, their representatives and staff were encouraged to express their ideas and thoughts. As such, the atmosphere within the service was relaxed, friendly and inclusive. People felt able to raise issues or concerns, confident that they would be dealt with sensitively and appropriately.

Quality assurance processes were robust and action plans to improve the service were prioritised and completed quickly. Learning was shared from within and outside the organisation and community contacts were well established. National best practice legislation and local policies were referenced to set and measure standards of care.

There was a registered manager in place who was present on the day of the inspection. 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.

There were not always enough staff deployed around the service to consistently meet people’s needs. People sometimes waited long periods of time before they received support from staff particularly around meal times.

There were areas around the service that required cleaning including one of the medicine rooms and one of the sluice rooms. Other areas of the service were clean and well maintained.

There were not always effective systems in place to assess and monitor the quality of the service. Audits had not always identified areas that required improvements. However other audits and surveys had been undertaken with people, relatives and staff but had been used to improve the quality of care for people. Records were not always stored appropriately or easy to access.

People’s medicines were administered and stored safely. Risks had been assessed and managed appropriately to keep people safe which included the environment. The risk assessments for people were detailed and informative and included measures that had been introduced to reduce the risk of harm. In the event of an emergency, such as the building being flooded or a fire, there was a service contingency plan which detailed what staff needed to do to protect people and make them safe.

Accidents and incidents with people were recorded electronically with a written copy kept in a file. Staff had knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse. Staff had undergone recruitment checks before they started work. People said that they felt safe.

People’s rights were protected under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring that people were consenting to their care. This also ensured that where restrictions to people’s freedom and liberty had been undertaken, these had been authorised by the local authority.

People were not always cared for by staff who had received appropriate training and knowledge specific to the needs of people who lived at the service. However all staff were kept up to date with the mandatory training including moving and handling and health and safety. Staff did provide good care to people on the day of the inspection.

Staff were supported in their work and said that they had regular supervision with their manager. There were opportunities for staff and their manager to discuss their performance.

The building met the needs of the people that were living there in particularly those who were living with dementia. There were destination points and signage to help orientate people around the service and assist with their independence.

Nutritional assessments were carried out when people moved into the home which identified if people had specialist dietary needs. People had access to a range of health care professionals, such as the GP, dietician and podiatrist.

Staff at the service were caring and supportive and staff treated people with dignity and respect. People told us they were involved in planning their care. Care plans had detail around people’s backgrounds and personal history and included people’s views on what they wanted. Staff knew and understood what was important to the person.

People were supported by staff that were given appropriate information to enable them to respond to people effectively. Where it had been identified that a person’s needs had changed staff were providing the most up to date care.

People were able to take part in activities which they enjoyed. People and relatives told us that they knew what to do if they were unhappy about something. There was a complaints procedure in place for people and relatives to access if they needed to.

Staff said that they felt supported, valued and listened to. Systems were in place to monitor the quality of the service that people received. This included audits, surveys and meetings with people and staff.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The registered manager had informed the CQC of significant events in a timely way.

We have made some recommendations in the full version of the report.

We found considerable improvements had been made in the cleanliness and the environment was a much more pleasant place for people to spend their time.

"SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us."

People were treated respectfully and their views were taken in to account by staff.

People who could communicate with us in a meaningful way told us staff were caring. Relatives spoken with told us their family members "were always asked for their consent and were treated with dignity and respect".

Risks to people's health and welfare were assessed and care was planned and delivered according to people's needs. One relative told us "I think this is a great home, staff are very attentive and they could not care for my husband any more than they do."

People were encouraged and supported with their meals and they appeared to enjoy the meal time, one person said "The food at the home is good."

Some infection control practices at the home were poor.

People's health and welfare needs were met by sufficient staff that had been properly vetted and were fit to work at the home.

People's complaints were listened to and dealt with appropriately.

We observed the manager on a number of occasions during the day interacting with the people living at the home. These observations showed us she knew the people well and had a good understanding of their needs and they responded positively to her. We also observed staff interacting with people throughout the inspection and heard them speak with people respectfully and seek people's views regarding day to day life in the home.

Relatives spoken with were very positive about the quality of care at the home, for example " it such a lovely place, my Mum is safe and well cared for", "staff always keep me informed about my Mum's care needs and if anything changes", "I am invited in to various activities going on at the home" and " the staff are lovely, always polite and couteous", " I am so relived my Dad is in such safe hands.