This inspection site visit took place on 11 and 12 December 2018 and was unannounced. Jubilee Gardens 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.
Jubilee Gardens accommodates up to 50 people in one adapted building. The home has two floors. It provides residential and nursing care to older people who live with dementia. During the first day of our inspection visits 43 people lived at the home and one person was in hospital. On day two 42 people lived at the home. The home is located in Castle Bromwich, West Midlands.
We last inspected Jubilee Gardens in December 2017 and gave the service an overall rating of 'Requires Improvement'. The inspection identified breaches of Regulation 12 ,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not always enough staff available to keep people safe, risk associated with people’s care was not safely managed and the provider’s quality monitoring systems were not effective.
Following that inspection, the provider sent us an action plan, and which confirmed the actions required to make improvements would be completed by the end of March 2018.
At this inspection we found the provider had not fully addressed the issues we identified at the last inspection. We also found areas where the home had previously performed well had not been maintained.
This is the second consecutive time the home has been rated as Requires Improvement.
The service did not have a registered manager. A requirement of the service's registration is that they have 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.
The provider had appointed a new manager who was planning to apply to register with the Care Quality Commission (CQC). They had been in post for three weeks at the time of this inspection.
People did not always receive safe care because some known risks continued to be inconsistently managed and other risks we found had not been assessed. Action was taken to address this.
Staffing levels continued to affect the standard and consistency of care people received because there were not always sufficient numbers of staff available when people needed them and to keep people safe. Despite this people told us they felt living at Jubilee Gardens.
People’s medicines were not always managed and administered safely.
The management team and staff worked in partnership with other professionals to support people to maintain their health and well-being. However, recommendations made by health care professionals were not always followed and staff did not always make timely referrals to health care professionals when needed.
Improvements had been made to the accuracy and level of detail in some people’s care records. However, further improvement was required to ensure staff had the information they needed to provide safe care. Action was planned to address this. Most staff demonstrated a good understanding of the needs and preferences of the people they supported.
Staff were recruited safely and received an induction when they started work at the home. The provider supported staff through a programme of on-going training. However, staff had mixed views about the training they received. Improvements had been made to ensure staff had the opportunity to meet with the management team to discuss their role and development needs.
Management systems to check, monitor and improve the quality and safety of the service remained ineffective. Most people and relatives felt the home was well managed. The provider sought feedback from people and relatives. However, it was not clear how feedback provided was used to make improvements to the service provided.
Staff understood how to protect people from abuse and their responsibilities to raise any concerns. However, the management team had not consistently followed safeguarding procedures.
People and relatives felt most staff were caring and kind. People, mostly, received their care and support from staff who they knew. Significant improvements had been made to the opportunities available to people to take part in meaningful activities.
People’s dignity was, at times, compromised. Relatives and friends could visit the home at any time and people were encouraged to maintain relationships which were important to them. Complaints were managed in line with the provider’s procedure.
The provider was working within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, some staff were not clear about authorised restrictions on people’s liberty.
Staff gained people’s consent before they supported people and respected people’s decisions and choices. Staff respected people’s privacy and supported people to maintain their independence.
We found a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.