Archived: Jubilee Court

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the last inspection of the service in June 2017, the provider was rated as Requires Improvement in all five key questions. They were also in breach of regulations because they did not have effective systems of governance to assess, manage and monitor risks to people living at the service. Following the last inspection, we served a Warning Notice to require the provider to take immediate action in relation to their governance. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well-led to at least good.

At this inspection, we found that regulations had been met, and there had been improvements across all five key questions.

People were supported by trained staff who understood how to recognise, and report abuse or harm. A clinical lead nurse had been recruited which had improved the oversight and management of risks to people’s safety in relation to their medical conditions. Risks assessments were up to date and showed what support people needed to keep them safe. People were supported by sufficient numbers of staff and safe recruitment practices were followed. People received their medicines as prescribed. Shortfalls in nurses keeping accurate medicine records were being addressed with improved checks in place to enable the provider to identify and act on errors.

People received effective care from staff that had the skills and additional training specific to the needs of people. Staff had an induction and regular supervision and described positive support from the management team. Staff had additional support to enable them to understand the Mental Capacity Act and we saw they supported people in line with its principals. 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. People’s dietary needs were met; they enjoyed the meals provided and had assistance to eat and drink sufficient amounts. People were supported to maintain their health and had access to a range of healthcare professionals. This included on-site therapists who supported people to manage their medical conditions.

Staff were caring towards people and demonstrated a compassionate response to people’s personal circumstances and needs. People were supported with their privacy and dignity.

People had been enabled to identify their personal goals in relation to developing their skills and level of independence. They were involved in the development and review of their care plan. The resources needed to support people were identified and we saw people had benefitted from the combined efforts of the therapist team and care staff to develop their strengths and quality of life. People enjoyed a range of activities and social opportunities which focused on their personal interests and included opportunities for voluntary work and maintaining educational interests. People knew how to raise concerns and were happy these would be responded to.

The provider’s quality assurance systems and processes had improved. We saw audits were carried out regularly and had been effective in identifying areas for improvement. The systems in place had enabled the provider to assess, monitor and manage risks to people’s safety. We found the introduction of a clinical lead nurse had improved the clinical oversight of people’s needs. Records had been improved to show the clinical support people needed and provided. Feedback from external professionals recognised improvements had been made. The provider had addressed shortfalls identified at the previous inspection in relation to staff knowledge regarding people whose liberty was restricted. They had also sourced additional training to support staff in meeting people’s complex medical conditions. There had been an improvement in maintaining up to date care records. The checks in place helped the provider to ensure people who used the service were not at risk of unsafe care. As the provider was previously rated requires improvement on three consecutive inspections the improvements now need to be sustained.

The service has a manager in post who has submitted an application to the Care Quality Commission to become the registered manager. The previous registered manager left in December 2016.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 a comprehensive inspection in May 2016 we found the provider was not meeting the law in respect of the governance of the service and provision of systems which effectively assessed, managed and monitored risks to people living at the service. We also found at the May 2016 inspection the provider needed to make improvements to ensure staff were familiar with the Mental Capacity Act. We carried out a focused inspection in December 2016 and found the provider had made improvements which meant they were meeting the law. At this inspection in June 2017 we found improvements had not been maintained and the provider was again not meeting the law in respect of ensuring there were systems of good governance.

Most people received their medicines as prescribed. Some medicine shortfalls had not been identified and addressed in a timely manner. The lack of a clinical lead to oversee the clinical support provided to people impacted on the care and treatment people received. Assessments of risks had not always been completed or followed in relation to some people’s medical and healthcare needs. People’s needs were met by sufficient members of staff but we did see instances when the deployment of staff impacted on the way these needs were being met. Staff had received training and knew how to recognise and respond to abuse. Staff were recruited in a safe way.

Some improvements had been made and staff were familiar with the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). However staff were not fully aware of how to support people in the least restrictive way, and the provider was not always able to demonstrate how they were complying with the requirements of people’s Deprivation of Liberty authorisations. Staff generally sought people’s consent before providing their support. Staff received training for their role but not all staff had completed training which was specific to the needs of the people they supported.

People were supported by staff who they described as kind, friendly and caring and who protected their privacy and dignity. People were treated as individuals and their personal preferences were respected. People knew how to raise concerns and a procedure was in place, although we found that not all complaints had been recorded to enable us to see the action that had been taken.

People were supported by a therapist team that focused on their rehabilitation goals and aspirations. The provider employed activity coordinators who facilitated a range of activities, and encouraged people to participate in activities that they enjoyed. People were supported to maintain relationships with people who were important to them and visitors were welcomed in the home

Although the provider had quality assurance systems and processes in place to support them to monitor the quality and safety of the service, some of these systems and processes had not identified the shortfalls that we found during our inspection and further improvements were required. We found that although the provider addressed the concerns and shortfalls as they were identified a more proactive approach was not being followed to ensure improvements were sustained and lessons were learnt.

We found the provider was in breach of one of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection at this service on 9 and 10 May 2016. We found the service was in breach of a regulation. This related to there being ineffective quality monitoring systems in place to monitor the quality of the records, medicines, training and support systems in place for staff. After the inspection, the provider wrote to us telling us what action they would take to meet the legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their action plan and to confirm that they now meet the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Jubilee Court Neuro –rehabilitation on our website at www.cqc.org.uk.

Jubilee Court Neuro- rehabilitation is a purpose built rehabilitation centre. It provides accommodation with personal care and nursing for up to 30 adults who have acquired brain injury. At the time of our inspection 21 people were using the service.

A registered manager was not in post she had left the service the week of our inspection. The service did have an acting manager in post who told us she would be submitting an application to register with us. 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 provider had taken action and the legal requirements had been met. We found that sufficient improvements had been made to monitor the quality of the service.

We found that action had been taken to ensure people received their medicines in a way that they could manage and in accordance with their best interests.

We found that further improvements were required to ensure staff were fully aware about which people had a Deprivation of Liberty Safeguard (DoLS) authorisation in place

Care records had been reviewed with people and these reflected people’s needs, aspirations and their rehabilitation goals. Records which monitored people’s fluid and food intake had been completed in full.

Staff told us they felt supported and received regular supervision. Seniors told us they had received training to ensure they had the skills and knowledge to provide leadership and support to staff.

We saw that the provider completed regular audits to ensure records were completed and were up to date and to monitor the quality of the service that was provided.

The service has a manager in post who has submitted an application to the Care Quality Commission to become the registered manager. The previous registered manager left in September 2015.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 our last inspection in November 2014 the provider was not meeting regulations associated with the Health and Social Care Act 2008 which related to the training of staff, not having systems for obtaining feedback from people and their families, not managing risks effectively, not having regard for CQC reports and how the quality of the service was assessed. We told the provider to take action. Following that inspection the provider sent us an action plan which highlighted the action they would take to improve. During this inspection we found that most of these improvements had been made, or were in the process of being implemented.

The providers quality assurance systems had not been effective in identifying the shortfalls and issues in the service.

You can see what action we told the provider to take at the back of the full version of the report.

People received their medicines as prescribed. People told us that staff knew them well and supported them in their preferred way. Staff knew how to support people safely and had training in how to recognise and report abuse.

Staff were recruited in a safe way. We found there was enough staff to support people and meet their needs.

Staff had the relevant information on how to minimise identified risks to ensure people were supported in a safe way. Although staff sought people’s consent before providing support they were not fully aware of which people had deprivation of liberty authorisations.

People were treated with kindness, and respect and staff promoted people’s independence and right to privacy. People were supported to maintain good health; we saw that staff alerted health care professionals if they had any concerns about their health.

People knew how to make a complaint and were confident that their complaint would be investigated and action taken if necessary.

Staff morale had improved and staff felt supported by the management team. People described the management of the home as friendly and approachable.

We spoke with five people who used the service, relatives of four people who used the service, the registered manager, the clinical lead and seven members of staff.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We spoke to five people who used the service and relatives of a further four people. All of these people confirmed that they felt safe when being supported by care staff.

People told us that care staff knew how to care for them. We spoke with care staff and looked at records. We saw that staff had the skills and knowledge to support a person when their health and care needs changed or if a person suddenly became unwell. Care was delivered in a way which kept people safe.

The provider worked with other agencies to investigate issues of concern to ensure people were kept safe.

Care records were completed and up to date. This meant that staff had information they needed in order to care for people safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. When applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit an application.

Is the service effective?

People's health and care needs had been reviewed with them. There was appropriate information in people's care plans about the support they needed and how they wanted to be supported. A person who used the service told us, 'It is very good care'

Where necessary, risk assessments had been undertaken and were used to help staff provide appropriate, safe and consistent support to people who used the service. Care plans contained information and guidance about people's specific conditions to enable care staff to meet the individual needs of the people who used the service.

Staff were supported to develop the skills and knowledge they needed to meet people's care needs, however not all staff had regular supervisions or staff meetings. Some staff told us that it was not always clear who was in charge when they were on duty. This meant that that there was risk that people were supported by staff who could easily access guidance on how to deliver the care people needed. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that staff receive appropriate supervision and appraisal.

Is the service caring?

All the people we spoke to confirmed that staff were kind to them. Comments included, 'The staff are very good,' and 'You can't fault them; they know my relative's needs very well.' We observed staff respond promptly to people's individual care needs and wishes and saw that they promoted social interaction.

When speaking with staff it was clear that they genuinely cared and knew about the people they were supporting. People's preferences, interests, aspirations and diverse needs had been recorded and support had been provided in accordance with people's wishes.

Is the service responsive?

We saw that people were regularly asked if there was anything they needed. People told us that the provider made them feel comfortable to raise concerns. We saw that the provider responded appropriately to concerns so that the service could improve.

The provider had a complaints policy which showed people how to make a complaint if they were unhappy. The manager was aware of the provider's policy and knew how to respond to concerns. We saw evidence that the provider had taken action when complaints were raised.

The service worked well with other agencies and services to make sure people received care in a coherent way. People were supported to attend doctors, dentists and other health appointments when needed. The provider supported people to seek the opinions of other health providers in order to gain further information about specific conditions.

Is the service well-led?

There was evidence that the provider had ensured that learning from incidents or accidents took place and appropriate changes were introduced or implemented to keep the people safe from harm.

The provider did not regularly seek the views of the staff or people who used the service about how to improve the service. People were approached individually to discuss their care needs however the provider had not held any service user or staff meetings to enable people to discuss the quality of the service since October 2013.

Staff told us they were not always sure about their lines of accountability. Some staff told us that they did not always know who to report concerns to and that sometimes there was no member of staff on duty with overall responsibility for the service.

The service had a quality assurance system in place however audits were not always completed. For example we saw that audits which supported the provider to review the quality of the care people received, such as infection control, health and safety, cleaning and equipment were not completed as frequently as the provider's policy had identified necessary to assess the quality of the service. This meant that the provider did not have a robust audit system to ensure that the service met the care and welfare needs of the people who used the service. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that they have a robust system to assess and monitor the quality of the service.

We spoke with eight people who lived at the home and five visiting relatives. We observed how care was provided to people and looked at five people's care records. We also spoke with six members of staff, the manager and the provider.

We found that people or their representatives were now more involved in planning their care and treatment.

We found that people's consent was sought, or where people had difficulty making decisions the manager knew how to involve other people and agencies to ensure their best interests were promoted. One person told us, 'They check my care plan every few months and I sign it'.

We found that the care that people received was now more consistent and people received more care and treatment at the times they expected or needed it.

People told us that staffing levels had improved and the quality of the staff that cared for them was better than it had been. One person told us, 'All staff are alright, can talk to if problems and they are all good to you. They are pretty good'.

We found that there were some instances where records were not up to date, or inconsistent this presenting a potential risk to the consistency of people's care.

Most people were able to tell us their views of the service, one person said, 'It is a really nice place to live, the staff are great and I have made so much progress which I would not have done without their help'. Another person told us, 'There are some good things, but I don't like the restrictions, it feels a bit like a prison'.

Some people due to their complex care needs were unable to talk with us so we spent time observing their care and talking with relatives. We found at times there was little positive interaction between staff and people using the service. We saw some but not all staff talked with people or sought permission before assisting them with their mobility.

We found people's care plans were not person centred and staff were unaware of their personal routines. We found people were not always supervised as they should have been to ensure their welfare and safety. People's care and welfare was recorded but there were omissions that put people at risk.

The provider had systems in place to protect people from harm or abuse but arrangements for ensuring people were kept safe were not followed.

The premises were modern, spacious and clean. There were potentially serious issues with the personal comfort of people and temperature control.

The appropriateness of coded locks on doors restricted people's liberty. One person told us, 'We have to ask and wait for a door to be opened, it is very demeaning'.

People who used the service, relatives and staff said there was not enough staff to provide the care people needed. Recent staff sickness had impacted on the provision of care. There were concerns about the delegation of staff to ensure people were supported with their needs.

Overall we found the provider did have a quality assurance system to monitor the service provision. However this had not effectively captured the omissions in care records, care delivery or risks this created.