This inspection was carried out on the 18 and 20 March 2015. Jubilee House is a service that is registered to provide accommodation for 48 older people most of whom are living with dementia and some of whom require nursing. The service also provides respite care. (Respite care is a service giving carers a break by providing short term care for a person with care needs). The registered provider is Care UK Community Partnerships Ltd. Accommodation is provided over two floors and is divided into four separate units, two on each floor. Each unit can accommodate a maximum of 12 people and has a lounge, dining area and a small kitchen. On the day of our visit 35 people lived at the service.
At the time of the inspection there was 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.
There were not enough staff on duty; this meant that there was a risk that people’s needs were not always met. Staff felt that they did not always have time to spend with people. This is a breach of regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Relatives said they felt their family members were safe. One said “I feel my (family member) is safe, I can go home knowing that they (staff) are looking after him.” Staff understood what it meant to safeguard people from abuse and how to report any concerns.
Risk assessments for people were up to date and detailed. Each risk assessment gave staff information on how to reduce the risk. These included risks of falls, isolation and choking. Staff displayed a good understanding of people’s risks.
There were complete pre-employment checks for staff. This included full employment history and reasons why they had left previous employment. This meant as far as possible only suitable staff were employed.
Staff did not always have the most up to date guidance in relation to their role. Nurses were not always supported to provide the most appropriate care to people as there was no clinical lead at the service to provde the support needed to staff. Clinical staff did not always feel supported to undertake their role.
Staff underwent regular one to one meetings with their manager however no appraisals had taken place for staff. There were mixed reviews about the competencies of staff from health care professionals. One told us that staff did not always manage people’s care in the correct way. This is a breach of regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff had knowledge of their responsibilities under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). However the registered manager had not submitted DoLS applications to the local authority for people in the service where it was appropriate to do so. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) where it applies to care homes. We saw that for those people who lacked capacity and ‘Do not attempt resuscitation ’ (DNAR) forms had been completed fthere was no evidence that mental capacity assessments had been completed. This is a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff gave examples of when they would ask people for consent in relation to providing personal care. We saw several instances of this happening during the day.
People and relatives said that the food was good. People were encouraged to make their own decisions about the food they wanted. We saw that there was a wide variety of fresh food and drinks available for people. Those people who needed support to eat were given it.
People had access to other health care professionals as and when they required it. The opinions of the health care professionals had been sought in a timely way.
The design of the environment helped people living with dementia to be as independent as possible.
Relatives said that staff were kind and caring. One told us “I cannot fault the care that (their family member) has received in any way, the staff are excellent.”
People were treated with kindness and compassion by staff throughout the inspection. Staff acknowledged people warmly and sat talking with people.
Staff read people’s care plans before they provided any care in order to understand who people were. They knew what was important to people. People had the opportunity to be involved in the running of the service. Residents meetings were held and the minutes showed discussions about the food people liked and what they didn’t like and the things people wanted to do.
People were treated with dignity and respect. Staff knocked on people’s doors and waited for a response before entering and personal care was given in the privacy of people’s own rooms or bathrooms.
Relatives felt that staff understood their family member’s needs. One said they felt assured when they were not there staff would know and understand what (their family member) needed.
Complaints were not recorded and responded to in a timely way. Although there was a complaints policy there was no system of logging the complaints and learning from them. This is a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Where people had a specific mental health need pre-assessments were not always undertaken by an appropriate qualified person at the service. This meant that the needs of the person may not be fully understood by staff.
People’s personal history, individual preferences, interests and aspirations were all considered in their care planning. Plans provided staff with information so they could respond positively, and provide the person with the support they needed in the way they preferred.
Relatives were not always communicated with in a timely way. Where GPs had been called to see their family members they were not always contacted straight away.
Care plans were reviewed every month to help ensure they were kept up to date and reflected each individual’s current needs. We found instances where a change had occurred and care was changed to reflect this. Staff responded to people’s needs as and when they needed it.
There was a programme of activities in place and an activities coordinator on each floor. Activities included entertainment, cooking, baking, bingo, arts and crafts, and reminiscence sessions. People were also supported to access the outside community.
Audits of systems and practices carried out were not always effective. Where concerns had been identified these were not always addressed. Incidents and accidents were recorded but there was no analysis of these. Records were not always maintained in a clear way. Where people needed to be closely monitored there were no forms in people’s rooms to record when and what was being done. This is a breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff said they did not feel supported or motivated in their jobs. There were no systems in place to ask staff how they would like to contribute to the service being run. Staff had not been surveyed to establish how they felt. This is a breach of regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff meetings were held but staff felt that they were not listened to.
Relatives meetings were organised where discussions took place around events and work being carried out in the service. There was a quarterly newsletter for the service which included information on new staff, staff’s achievements, recent events, people’s birthdays and upcoming events.
Annual surveys were sent to the relatives but there was no evidence of what action needed to be reviewed as a result of the survey.
You can see what action we told the provider to take at the back of the full version of the report.