Jubilee Lodge

Jubilee Lodge is a residential nursing home providing accommodation, personal and nursing care to up to 74 people across four separate wings. The service provides support to people with nursing needs and people who live with dementia. At the time of our inspection there were 55 people using the service.

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

We saw improvements had been made since our last inspection as quality assurance systems to monitor the safety of the home through audits and staff management had been strengthened. Records had now been maintained to show how staff related concerns had been safely and effectively managed. However, we identified some concerns in relation to medicines specific care plans. We have therefore made a recommendation about the governance and oversight of the management of medicines.

People were protected from the risk of abuse, and the provider had systems and processes in place to safeguard people. People and relatives told us they felt safe and were positive about the staff who supported them.

The service worked in partnership with health and social care professionals to ensure people had the best outcomes.

The provider was working towards greater consistency for people and had increased permanent care staff to reduce the reliance upon agency staff. The provider was now looking to achieve the same consistency amongst the nursing team. The improvements already made in staffing had positively impacted upon personalised care for people.

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

People and relatives spoke positively of the care that was provided. One person said, “I have no criticism at all. I have no dependents and I am very grateful to be here…It is the answer to my prayers. This is my home.”

Quality assurance processes included a variety of audits. Despite the concerns we raised in relation to medicines, it was evident that the manager had a clear oversight of the service and how to sustain and develop ongoing improvement.

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

Rating at last inspection

The last rating for this service was requires improvement (published 28 April 2022).

At our last inspection we recommended that the provider review their systems to respond, investigate and monitor concerns relating to staff conduct. At this inspection we found the provider had acted on the recommendation and made improvements in this area.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jubilee Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to safe care and treatment relating to medicines management at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Jubilee Lodge is a residential nursing home providing accommodation, personal and nursing care to up to 74 people. The service provides support to people with nursing needs and people who live with dementia. At the time of our inspection there were 46 people using the service.

Jubilee Lodge accommodates people across four separate wings. One of the wings specialised in providing care to people who required a short period of recovery and therapy before they returned to their own home. Due to the pandemic this wing had been temporarily suspended, and people were currently accommodated across the three other wings of the home.

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

Since our last inspection the provider had appointed a new manager. The new management team were enthusiastic to drive improvement and ensure people received safe and effective care from a supported and motivated staff team.

The provider had prior to our inspection identified that improvements were needed in the service and was working to complete their service improvement plan. The provider was visiting the home every week to speak with managers and staff and ensure actions identified on their service improvement plan (SIP) were achieved.

We found some time was still needed to ensure the provider’s medicine, recruitment and stakeholder feedback policy and audits were effectively implemented and embedded in practice.

Records had not always been maintained to show how staff related concerns had been safely and effectively managed. We have made a recommendation about the recording of investigations and information of concern.

Staff understood their role in keeping people safe. There were enough staff to meet people's needs but due to staff vacancies, there continued to be a reliance on support from agency staff. The provider continued to actively recruit for more permanent staff.

Staff were positive in their comments of the care provided. People and relatives spoke positively of the care that was provided.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Jubilee Lodge on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about the recording of investigations and information of concern.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

A registered manager was in place as required by their conditions of registration. 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 were cared for by staff who were passionate about improving people’s quality of life and who knew people well. People and their relatives praised the staff for their kindness and support. Staff supported people to attend health care appointments as required. The registered manager and staff had acted on people’s views and personal wishes to improve their life at Jubilee Lodge. People enjoyed the meals provided. They were being consulted about their likes and dislikes

People’s rights were protected. They were supported to make decisions about their care and support. People’s care records provided staff with detailed information about their support needs, personal histories and social interests. Their individual risks had been identified and assessed. Whilst staff supported people to minimise their risks, there was not always clear recorded guidance for staff to follow.

The registered manager and provider were actively recruiting new staff to ensure people were being cared for by a consistent and familiar team. The management and administration of their medicines was based on people’s individual support needs. The managers had taken action to address previous errors in the management of people’s medicines.

People benefited from staff who had been trained and supported to carry out their role. Staff understood their responsibility to safeguard people and report any concerns. Plans were in place to implement and monitor the system to support staff. A clear recruitment process was in place to ensure people were supported by staff of good character. However conversations about any discrepancies in their employment histories were not always recorded.

The registered manager had a good understanding of their role and how to manage the quality of the care provided to people. Quality monitoring systems were developed to check and address any shortfalls in the service; however the systems did not always monitor the skills of nurses and senior staff and the recruitment processes of staff. Where concerns had been raised by people and their relatives these had been addressed immediately.

Jubilee Lodge is a purpose built home set over two floors and divided into four units known as households. Each household has a small kitchen and adjacent dining room and a variety of lounges and quite areas to sit in. The home had a shop, activities room and hairdressers.

A registered manager was in place as required by their conditions of registration. 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 and their relatives were positive about the care they received and felt safe. There were caring and friendly interactions between staff and people. Relatives felt welcomed at any time and could take part in the home’s activities.

People were being supported by suitable numbers of trained staff. Staff had been trained in understanding their responsibilities in reporting any allegations or incidents of abuse. Staff were knowledgeable about people’s physical, mental and emotional needs. People’s risks had been assessed and monitored by staff. They were referred to external health care services if there were changes in their wellbeing. The management and administration of people’s medicines was based on their individual support needs. People enjoyed the meals provided. They were encouraged to eat and drink. People’s specialist diets were catered for.

People’s support plans included information about how they preferred to be supported. Staff were knowledgeable about their needs, wishes and preferences. However, the details of the lawful consent to receive care were not always evident when people could not make a decision about their care and support for themselves. They received care which reflected their individual preferences and routines. Staff had a good understanding of their personal histories and knew people well. However, some people’s care plans had not been updated to reflect their needs. People’s daily notes were variable and often focused on tasks rather than people’s well-being. However, staff were knowledgeable about people’s risks, changes in their needs and support requirements.

Staff listened and acted on people’s concerns. Events and information about the home was shared with people and their relatives. People’s recreational and social needs were met. They enjoyed activities in the home as well as places of interest in the local area.

Systems were in place to ensure people were supported by staff who had been supported to carry out their role. Their previous employment history and background had been checked. Staff said they felt supported and could raise concerns with the registered manager. The registered manager had a good understanding of their role. They provided support to staff to ensure people’s health needs were being monitored. Quality monitoring systems were in place to check and address any shortfalls in the service. Where concerns had been raised by people and their relatives these had been addressed immediately.

Staff had received training to safeguard people from abuse and people we spoke to who used the service confirmed that Jubilee Lodge was a safe place to be. We found that there were arrangements to provide enough staff to meet people's needs. When we asked people about how staff responded when they used the call bell, one person using the re-enablement unit told us, "always somebody comes". We found that there were systems in place to monitor the quality of the service provided to people.