Archived: Jasmin Court Nursing Home

We checked progress the registered provider had made following our inspection on 19 April 2018 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were Regulation 9, Person-centred care; Regulation17, Good Governance; and Regulation 18, Staffing.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least good. During this inspection we found the registered provider was no longer in breach of Regulation 17 and 18. However, we found further breaches of Regulation 9 and a breach of Regulation 12, Safe care and treatment.

Jasmin Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Jasmin Court is located in north Sheffield and is registered to provide accommodation for up to 50 older people who require nursing and/or personal care. Accommodation is provided over two floors, accessed by a lift. A dining room and two lounges are situated on the ground floor of the home. There were 26 people living at Jasmin Court at the time of this inspection.

There was not a registered manager at the service. The service was being managed by an interim manager and the regional 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.

Medicines were not always managed and administered in a safe way.

Drinks were offered to people throughout the day, however these were left on tables beside people who required support from staff to drink. This support was not always given and we saw people with several full cups of untouched drinks left beside them.

There was a limited range of activities on offer to people living at Jasmin Court. Some people and their relatives told us they would like more activities and of a wider variety.

We saw the signage and decoration of the premises could be improved and updated to better meet the needs of people living there.

Not all the quality assurance and audits systems in place to monitor and improve service delivery were effective.

From our observations we saw there were enough staff employed to meet people’s care and support needs in a timely way. However, people and their relative’s views on staffing levels were mixed.

Safe recruitment procedures made sure staff were of suitable character and background.

There were systems in place to recognise and respond to any allegations of abuse. Staff had received training in this area. Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by management.

Systems were in place to ensure people were supported by staff who had the knowledge and skills necessary to carry out their roles in meeting people’s needs. Staff were suitably trained.

People told us they enjoyed the food served at Jasmin Court, which we saw took into account their dietary needs and preferences. People were assisted to maintain their health by being provided with a balanced diet and supported to access a range of health and social care professionals.

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 and their relatives told us the staff were kind and caring. We saw positive interactions between people, their relatives and staff throughout this inspection. Staff knew people and their preferences well. People told us they were treated with dignity and respect.

There was a complaints policy and procedure. This was clearly displayed in the reception area.

People’s care records reflected the person’s current health and social care needs. We saw these were evaluated monthly.

The registered provider had policies and procedures which reflected current legislation and good practice guidance.

Safety and maintenance checks for the premises and equipment were in place and up to date.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were a breach of Regulation 9, Person-centred care and Regulation 12, Safe Care and Treatment.

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

Jasmin Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Jasmin Court is registered to provide accommodation for up to 50 older people who require nursing and/or personal care. Accommodation is provided on the first and second floors, accessed by a lift. Communal areas such as dining rooms and lounges are situated on the ground floor of the home. At the time of the inspection, 28 people were living at the home; one of those people was in hospital.

At the time of this inspection, the service was being managed by the regional manager and the deputy manager. The previous manager had recently left and had not registered with the Care Quality Commission. 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 we spoke with told us they felt ‘safe’. Relatives we spoke with did not express any concerns about their family members’ safety. However, we received concerns from relatives about the staffing levels at the service, particularly at the weekends.

At our last inspection, we saw the deployment of staff, particularly during mealtimes, could be improved to ensure people were supported appropriately. At this inspection, we saw the arrangements in place to ensure people in their rooms received their meals in timely manner still required improvement.

We found the management of medicines required improvement to ensure medicines were handled safely. We saw evidence of poor stock control and ordering of medicines.

Staff had access to important information to help keep people safe and take appropriate action if concerns about a person’s safety had been identified. Staff knew these policies and procedures were available to them.

We found the system in place to ensure that fit and proper persons were employed at the service needed to be more robust.

We saw there were satisfactory arrangements in place to manage people’s monies.

People we spoke with were satisfied with the quality of care they had received. However, we saw that some people had not been supported appropriately with their personal care. This did not uphold their dignity. This showed that sufficient improvement had not been made at the service since our last inspection.

We saw some practices at the service that did not promote dignity and respect. This showed some of the training and support of staff had not been underpinned by the key values of kindness, respect and dignity of care. We also saw some staff did not fully understand the requirements about offering choice and/or obtaining consent. This showed the service had not always been well led.

At our last inspection, we received mixed views from relatives about their involvement in their family member’s care planning. At this inspection we found the system in place to ensure that an assessment of needs involved relevant people still required improvement.

We saw that some people’s care plans had been rewritten and/or updated since our last inspection. We saw these care plans were more centred on the person and were being regularly reviewed. However, some care staff spoken with told us they had not read people’s care plans since they had started working at the service. This showed there was a risk that people would not receive appropriate care and staff had not been provided with sufficient guidance on the person’s current care and support needs.

Relatives we spoke with told us the level of activities and quality and suitability of activities could be improved. Comments included, “I don't think the activities always suit people with dementia” and “My [family member] cannot take part in anything, I'm not sure if they get a one to one visit.”

The registered provider had a complaint’s process in place and this was displayed in the reception area. Relatives we spoke with told us that concerns and complaints were listened to by staff.

At our last inspection, we found the registered provider had not ensured that staff received appropriate training and support to enable them to carry out their duties. At this inspection, we saw that sufficient improvement had not be made to ensure staff received appropriate induction and refresher training and support to enable them to carry out their duties.

At our last inspection, we found the registered provider had failed to ensure that people and their representative views were actively sought for the purpose of continually evaluating and improving the service. The deputy manager told us they had held relatives meetings since the last inspection, but nobody had chosen to attend them. However, some relatives we spoke with were not aware of these meetings or they told us they had never been asked to feedback about the quality of the service.

At our last inspection, we found the registered providers systems to assess, monitor and improve the quality and safety of the service required improvement. At this inspection we saw there were checks completed at the service by senior staff. However, we saw these checks did not always provide a timescale for completing improvement or detail when the action had been completed.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The manager had started working at the service in November 2016; they had not yet registered with the Care Quality Care Commission. The manager told us they had obtained the documentation to apply to become the registered manager, but they had not submitted their application yet. 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.’

Jasmin Court is registered to provide accommodation for 50 older people who require nursing and/or personal care. Accommodation is provided on the first and second floors, accessed by a lift. Communal areas such as dining rooms and lounges are situated on the ground floor of the home. At the time of the inspection 36 people were living at the home.

We saw the deployment of staff particularly during mealtimes could be improved to ensure people were supported appropriately and in a timely manner. We saw examples when people’s calls for assistance were answered promptly, but we also saw examples when this was not the case.

The registered provider’s recruitment policy needed to be updated. We found the system in place to ensure that fit and proper persons were employed at the service needed to be more robust.

We found that some people’s risk assessments required improvement to ensure care was provided in a safe way.

We found that the registered provider had not ensured that people’s care plans were regularly reviewed or in response to change. This meant there was a risk that people would not receive appropriate care. We found there was contradictory information in some people’s care plans. We also found that some people’s care plans did not reflect the care that was being provided by the care staff. The manager told us they were in the process of reviewing people’s care plans.

We found the registered provider had not ensured that staff received appropriate training and support to enable them to carry out their duties. The manager told us that a programme of staff training was being delivered at the service to bring staff up to date. The manager had a staff supervision schedule in place.

People were satisfied with the quality of the food that was provided at the service. However, a few people we spoke with told us sometimes hot food had gone cold by the time it was served. We shared this feedback with the manager so appropriate action could be taken to ensure food temperatures were check.

There was a programme of activities for people to participate in, but we saw there was no one to one activities provided to people who were unable to leave their rooms. It is important that all the people living at a service are provided with meaningful activities.

We reviewed one person’s Deprivation of Liberty Safeguards authorisation which had been granted with conditions in March 2017. These conditions are legally binding and we saw that some of these conditions had not been met. This showed there was a risk that people would not receive appropriate care and treatment to meet their needs.

We found the registered provider had failed to ensure that people and their representative views were actively sought for the purpose of continually evaluating and improving the service.

Our findings during the inspection showed the registered provider systems to assess, monitor and improve the quality and safety of the service required improvement.

People we spoke with told us they felt ‘safe’ and did not have any worries or concerns. Relatives we spoke with felt their family member was in a safe place.

The service had arrangements in place to manage medicines so people were protected from the risks associated with medicines.

People we spoke with were satisfied with the quality of care they had received. Relatives were also satisfied with the quality of care their family member had received.

Most of the people and relatives we spoke with told us that concerns and complaints were always taken seriously and responded to in good time. However, the feedback we received from a few relatives showed the systems in place to ensure the complaints process was followed by all staff needed to be more robust

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.

We saw the manager had held a number of staff meetings since they started working at the service. Regular staff meetings help services to continually improve.

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

We last inspected the service in October 2015 when we found three breaches in legal requirements and the service was rated as ‘requires improvement.’ The breaches were in respect of care and treatment not always being provided in a safe way, including the management of infection control, the premises not always being suitable for the purpose intended, and a lack of a robust system to monitor how the home was operating.

The provider sent us an action plan detailing what improvements they intended to make and by when. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Jasmin Court’ on our website at www.cqc.org.uk’

Jasmin Court is in north Sheffield and is registered to provide accommodation for 50 older people who require nursing and/or personal care. Accommodation is provided on the first and second floors, accessed by a lift. Communal areas such as dining rooms and lounges are situated on the ground floor of the home. At the time of the inspection 41 people were living at the home.

The service did not have a registered manager in post. However, there was a new manager who had been in post for around five months. They told us they had applied to become registered as manager with the Care Quality Commission. 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.

During this inspection we looked to see if improvements had been made since our last inspection in October 2015. We found that substantial improvements had been made.

The home had a welcoming, friendly atmosphere, which people said they liked. Throughout our inspection we saw staff supporting people in an inclusive, caring and responsive manner. They encouraged people to be as independent as possible, while taking into consideration their abilities and preferences. The people we spoke with told us they felt the home was a safe place to live and they were happy with the care and support they received. They made positive comments about how staff delivered care and said the available facilities met their needs.

We saw there were systems and processes in place to protect people from the risk of harm. The management team were knowledgeable about safeguarding people from abuse and all staff had received training in this subject. Assessments identified any potential risks to people and care files contained information about how to reduce these risks.

Medicines were stored safely and procedures were in place to ensure they were administered correctly. We saw people received their medications from staff who had been trained to carry out this role.

There was enough skilled and experienced staff on duty to meet the needs of the people living at the home and suitable pre-employment checks were undertaken before employing new staff.

Staff had received a structured induction on how the home operated and their job role at the beginning of their employment. They had access to a varied training programme and support to help them meet the needs of the people who used the service.

The requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were in place to protect people who may not have the capacity to make decisions for themselves. The MCA sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected.

Records demonstrated the correct processes were being followed to protect people’s rights, including when Deprivation of Liberty Safeguards were considered.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. We saw specialist diets were provided if needed and the people we spoke with said they were happy with the meals available.

Overall, care files reflected people’s needs and preferences in satisfactory detail and people had been involved in planning their care. However, records for people new to the service, or only staying for a short time, were not as detailed.

The home had an activity co-ordinator who facilitated a structured programme of activities which people said they enjoyed.

The provider’s complaints policy was available to people using and visiting the service. We saw that when concerns had been raised they had been investigated and resolved promptly. The people we spoke with raised no concerns.

There was an improved system in place to enable people to share their opinion of the service provided and the general facilities available. We also saw a structured audit system had been used to check if policies had been followed and the premises were safe and well maintained. Where improvements were needed action plans had been put in place to address shortfalls.

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

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

Is the service safe?

Where people were exposed to risk, this was not always adequately assessed.

The environment in which people were cared for was not hygienically clean, and some areas were damaged to the extent that they could not be cleaned to a sufficient standard. Staff did not always follow correct procedures in relation to cleanliness and infection control. We have told the provider that they must take action in relation to hygiene and infection control.

Is the service effective?

People did not always receive the care they were assessed as requiring, and did not always receive care or support in a timely manner. We have told the provider that they must take action in relation to people's care and welfare.

Is the service caring?

People's privacy was not always respected, and staff did not always take appropriate steps to uphold people's dignity. People were not always given sufficient opportunity to make choices about their care. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service responsive?

Staff did not always act when people required help or support. Where people's needs changed, their care plans did not always reflect this.There was a complaints system in place and this was accessible to people using the service. However, some of the information contained in the complaints procedures was incorrect. We have told the provider that they must take action in relation to people's care and welfare.

Is the service well-led?

There was a quality assurance system in place, where audits of all aspects of the service were carried out, however, it was not effective in identifying areas of concern. The system for monitoring accidents and incidents was inadequate as it did not identify where the provider had failed to meet certain legal requirements. We have told the provider that they must take action in relation to the assessing and monitoring of quality.

To check compliance, we reviewed the care records of six people. We found that the standard of records throughout Jasmin Court had improved. The home had implemented new care planning documentation and we found that, for the most part, this better enabled the home to maintain accurate and up to date records of people's health and social care needs.

During this inspection we identified that concerns noted about the flooring within corridor areas of the home during our inspection in April 2013 had not been adequately addressed. The uneven flooring and the provider's failure to adequately address this, continued to present a risk of people, staff and visitors tripping or falling.

During our inspection on 25 April 2013 we identified concerns about supporting workers. This was because the training staff had received about the Mental Capacity Act 2005 (MCA) had not equipped to know about the principles of the Act and how to apply the MCA in their day to day practice.

During our inspection in 22 August 2013 we identified concerns about the safety and suitability of the flooring within the corridor areas of the premises. The concerns identified posed a potential fall and trip risk to people, staff and visitors.

At the time of this inspection we were told 46 people were living at Jasmin Court Nursing Home. During our inspection we observed the care those people received, spoke with seven people who used the service, three family members, the registered manager and with seven members of care staff. We also reviewed a range of relevant documentation.

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: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

There were risk assessments in place where required for people using the service in relation to their support and care provision. People were not placed at unnecessary risk, but had choice and remained in control of their own decisions where they were able. This meant that people's independence was promoted and the least restrictive options used to maintain people's safety where necessary.

The environment that people were supported in presented some risks to their safety. Although some improvements had been made to the uneven corridor areas of the home, the ground floor still had some areas that were uneven. A water leak had occurred following the completion of this work. The remedial work needed to correct this had resulted in areas of the first floor corridor being uneven again. The registered manager had not identified the impact this may have on people who used the service and put plans in place to minimise this or informed stakeholders and CQC.

Work was needed to ensure water temperatures within the home were within legal guidelines to safeguard people.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safety and suitability of the premise.

Is the service effective?

People and their families described how they were involved in the assessment and care planning of their health and care needs, but this was not always evidenced in their individual assessments and care plans.

Other professionals had been involved when needed to support the service in meeting people's health and care needs. In the main, care plans contained up to date information and had been regularly reviewed, this meant care plans supported staff to meet people's needs.

We found that staff had received training or a supervision 'learning' session about the Mental Capacity Act 2005 (MCA). This had equipped them with knowledge about the principles of the Act and how they would apply the MCA in their day to day practice. The manager provided an example of how the Act had been put into practice with one person who was undergoing an assessment to ensure the home were not depriving them of their liberty.

Staff told us they felt supported and said that their supervision sessions were also being used to check their knowledge and share learning on different topic areas associated with their role.

Staff received training appropriate to their role, but we found one occasion where they did not put the fire training they had received into practice, which meant that people could have been placed at risk of harm in the event of a fire.

People described their meal time experiences as good. They told us that drinks were provided during the day and that they had a choice of meals. Their comments included, 'food is very nice. There's lots of choice' and 'there's plenty to eat ' too much sometimes.'

Is the service caring?

We spoke with seven people about the care provided at Jasmin Court. People were positive about the support they received. Comments included, 'I'm happy here, they're good to me,' 'I can have a bath/shower when I want. I don't need much help,' 'I'm very happy here. You've only to ask and they help. I've no grumbles at all,' 'It's alright here. You get spoilt to be honest. I have a bath or shower once a week. That suits me as it's what I had at home. I've seen my GP since I've been here. If I'd to rate it I'd say very good' and 'they're helping me find my feet again.'

There was a mixed response from families about their experiences of the care provided at Jasmin Court Nursing Home. Two families had positive experiences. Their comments included; 'it's excellent here. I've no worries at all. I've a good relationship with staff. They really look after [my relative]' and '[my relative] seems to be happy. [My relative] likes it there. I think staff have got a lot of time for [my relative]. They do everything they can ' they get doctors in when needed, they let me know if anything happens or [my relative's] poorly.' One family member told us that they were invited to meetings to discuss their relative's care and changes to their care plan.

On the first day of our inspection we received some concerns from one family about the care provided to their relative and the attitude of staff. These concerns were shared with the registered manager.

We found people were supported by caring staff that were attentive to people's needs. We saw that care staff showed patience and gave encouragement when supporting people.

Aspects of people's preferences, interests, aspirations and diverse needs had been recorded within their care plans. We noted that care and support had been provided in accordance with this information.

Is the service responsive?

We looked at three recent admissions to the intermediate care service. We saw that one admission had been reasonably well planned. The other two admissions had taken place when the home had not assessed the impact of a recent water leak upon the service and it's ability to meet the needs of people who continued to be admitted at this time. For example, one person had been unable to access their bedroom following their admission to Jasmin Court due to it being adjacent to the area of corridor affected by the water leak.

Is the service well-led?

The service had a quality assurance system in place, but we found this was not always effective in practice, because effective systems were not always in place to make sure that managers and staff learned from events such as complaints, concerns and investigations. This means risks to people were not always effectively identified, assessed and monitored to minimise any further risks and help the service to continually improve.

Workmen had stayed overnight at the home without appropriate checks and safeguards in place, because of a breakdown in communication between the manager and the workmen. This may have placed people at risk of harm.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from, complaints, concerns and investigations and how they plan to manage future maintenance that may take place at the home.

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

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People were positive about the support they received. One person stated, 'I'm happy here, I wouldn't want to live anywhere else.'

We saw that people's rooms were homely and personalised with their own belongings and found that appropriate checks had been undertaken to ensure the suitability and safety of the premises.

An effective recruitment process was in place to ensure that employees were of good character and held the necessary checks and qualifications to work at the home.

The training staff had received about the Mental Capacity Act 2005 (MCA) had not equipped them about the principles of the Act and how they would apply the MCA in their day to day practice.

We found that there was an appropriate system in place to gather, record and evaluate information about the quality and safety of care provided at Jasmin Court.

People were not protected against the risks of unsafe or inappropriate care and treatment due to some records containing a lack of proper information.

People were positive about the care and treatment they received at Jasmin Court. We saw that the direct care provided at Jasmin Court was safe, appropriate and took people's individual needs into account.

We found that Jasmin Court was clean and that staff were knowledgeable about how to control and prevent the spread of infection.

Our observations and conversations with people and staff demonstrated that people benefited from equipment that was used safely and met their needs.

We found that staff received a range of training courses as well as supervision and appraisal.

We found that whilst a policy and system was in place to investigate complaints, people were not always aware of this and that this was not always followed.

We identified a number of issues relating to the records in place at Jasmin Court. There was a lack of information within people's records that could result in people not receiving appropriate care and treatment. We also found that the majority of the records reviewed during our inspection did not detail or reflect the care observed during our inspection.