Jasmine Lodge

Jasmine Lodge is a residential care home providing personal care for up to 6 people. At the time of inspection there were 4 people living there. The service was a detached bungalow with a large garden within a small rural village. People had their own bedrooms. There were shared bathrooms, eating and living areas. The building had been adapted to meet the needs of people with physical disabilities. Some people had specialist needs associated with mental health and epilepsy.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

Risks to people were not always managed safely. Medicines that were prescribed on an as required basis were not always managed safely. Staff did not always have the information needed to support people in line with their current needs. However, the systems in place ensured that people were protected from abuse and improper treatment. Jasmine Lodge was kept clean. There were enough staff to safely meet people's needs. Emphasis had been placed on ensuring that staff had the skills, knowledge, and experience to meet people’s needs.

A person was enjoying increased independence following an operation to improve their eyesight. 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.

Right Care:

The service’s minibus had been off the road for at least 6 months so this had an impact on the number and quality of outings that could be provided. We observed that staff worked with people in a person-centred way to involve them as far as possible in all activities that were carried out around the home. This included laundry and cooking. Records of activities were basic and lacking in detail. Staff were caring in their approach and people responded warmly to them. We saw people smiling and responding with happy faces when staff spoke with them. Staff ensured people’s privacy was always maintained.

Right Culture:

Staff felt supported by the registered manager and team leader, but they felt they were not present in the home enough. The registered manager also felt stretched in the role with competing priorities. Staff told us they did not feel supported by the organisation.

Staff had not attended regular supervision meetings, but team meetings had been used to try to improve staff morale and staff all told us they worked well as a team and were generally happy in their work.

Following the last inspection extensive support had been provided initially to address the shortfalls we found. However, the frequency of auditing has meant that matters identified during this inspection in areas such as medicines management and fire safety had not been picked up. The provider had also introduced new electronic systems for care planning and storing records; some of the matters raised as part of our inspection were directly related to a lack of close monitoring. However, it is recognised that it is still early days with the new systems and processes.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 August 2022) and there were breaches of regulation. We served the provider Warning Notices under Section 29 of the Health and Social Care Act 2008. The notices require the provider to become complaint with breaches relating to risk, abuse, dignity, and governance.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 coronavirus 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.

The overall rating for the service has remained requires improvement.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We identified continuing breaches in relation to safety and governance 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.

About the service

Jasmine Lodge is a residential care home providing personal care for five people at the time of the inspection. The service can support up to six people. The service was a detached bungalow with a large garden within a small rural village. People had their own bedrooms. There were shared bathrooms, eating and living areas.

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

Right Support

Risks to people were not always assessed, monitored and managed safely. Systems in place did not always protect people from abuse and improper treatment. People’s medicine support was not being managed safely. People were not always supported to assess their needs effectively and did not always achieve good outcomes from their support. There were safe recruitment practices. The service was clean and hygienic.

Right Care

Staff did not always communicate or support people in dignified or respectful ways. Improvements were needed to make sure people were involved and included in a consistently personalised way when being supported by staff.

We observed caring interactions between some staff and people. Some staff were observed to encourage people to be as independent as possible. Professionals and relatives of people said some staff knew their family members well and acted in their best interests.

Right culture

Service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Internal quality assurance systems and processes to audit or review service performance and the safety and quality of care were not operating effectively to identify or resolve issues.

There was mixed feedback from staff and relatives about how involved and engaged they and people using the service were in developing the service. Not all staff felt confident about fulfilling their roles and responsibilities. Recent high staff and management turnover had affected morale and how well supported they felt by the provider.

The provider’s operations manager and Quality Improvement manager acknowledged the organisation’s governance framework required improvement to ensure people received safe and personalised care in line with CQC’s statutory ‘Right Support, Right Care, Right Culture’ guidelines.

There was a current organisational re-structure called ‘Transform 21’ in progress and new support delivery and oversight systems, processes and roles were being implemented over the next 12 months to improve the quality, safety and central oversight of all the provider’s services.

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

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

We received concerns in relation to people receiving uncaring support and not being kept safe from abuse and improper treatment. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, caring and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risks, abuse, dignity and respect, and governance. We served the provider Warning Notices under Section 29 of the Health and Social Care Act 2008. The notices require the provider to become complaint with breaches relating to risk, abuse and dignity and respect by 5 August 2022 ,and compliant with governance regulations by 5 October 2022.

Jasmine Lodge is a residential care home for six older people and younger adults who need support due to having learning adaptive needs/autism. At the time of this inspection five people were living in the service. All of these people had complex needs for support and used individual forms of sign-assisted language to express themselves.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who live in the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning adaptive needs/or autism to live meaningful lives that include control, choice, and independence.

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

People's experience of using the service:

People and their relatives were positive about the service. A relative said, "I do think that the service is very good. I can see from how my family member is in themselves that they see Jasmine Lodge as being their home.”

People were safeguarded from the risk of abuse.

People received safe care and treatment in line with national guidance from support staff who had the knowledge and skills they needed.

There were enough support staff on duty and safe recruitment practices were in place.

Medicines were managed safely.

Lessons had been learnt when things had gone wrong.

People had been helped to receive medical attention when necessary.

People and their relatives were consulted about the support provided and suitable arrangements had been made to obtain consent.

Arrangements had been made to address a small number of shortfalls in the maintenance of the accommodation and grounds.

Support staff were courteous and polite and confidential information was kept private.

Equality and diversity was promoted and people were supported to pursue their hobbies and interests.

There were robust arrangements to manage complaints.

There were arrangements to treat people with compassion at the end of their lives and to enable them to have a pain-free death.

People had been consulted about the development of the service and quality checks had been completed.

Good team work was promoted and regulatory requirements had been met.

Rating at last inspection:

The service was rated as ‘Good' at the inspection on 8 November 2016 and 9 November 2016 (the inspection report was published on 16 December 2016). At this inspection in May 2019 the overall rating of the service has been maintained as, ‘Good’.

Why we inspected:

This was a planned inspection based on the rating we gave the service at the inspection in November 2016.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received we may inspect sooner.

The service provides care and support to people living with a range of learning disabilities and longer term complex healthcare needs such as epilepsy. Most people living at Jasmine Lodge were unable to communicate with us verbally. People had been living at the service for between six to 17 years. There were six people living at the service on the day of our inspection.

We last inspected the service on 26 June 2014 where we found it to be compliant with all areas inspected.

A registered manager was in post. 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 and associated Regulations about how the service is run. The registered manager managed Jasmine Lodge and another service for the provider.

Although staff spoke positively regarding the leadership of the service, we found some issues with records and quality assurances systems which were not consistently providing senior staff with clear oversight of all areas of the service. The registered manager was responsive to our feedback and took corrective actions.

Medicines were managed safely in accordance with current regulations and guidance. There were systems to ensure medicines had been ordered, stored and administered, appropriately.

People appeared happy and relaxed with staff. There were sufficient staff to support them. Checks were undertaken to ensure staff were suitable to work within the care sector. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. A range of specialist training was provided to ensure care staff were able to meet people’s needs.

It was evident staff had spent time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. Areas included eating, falls and seizures. People consistently received the care they required because staff were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

People were provided with opportunities to take part in a range of activities and hobbies and to regularly access the local and wider area. People were supported to take an active role in decision making regarding their own routines and the routines and flow of their home.

Staff had a clear understanding of the vision and philosophy of the home and they spoke enthusiastically about working at Jasmine Lodge and positively about senior staff. Regular quality assurance reviews to monitor the standard of the service were completed internally and by the provider’s operations manager.

Below is a summary of what we found. The summary describes what people using the service and staff told us, our observations during the inspection and the records we looked at. At this inspection, we spoke with all of the people who lived at the service, three care staff and the manager.

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

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that care plans were sufficiently detailed to allow staff to deliver safe and effective care that reflected the support required in people's assessed needs.

People lived in purpose built, safe and well maintained accommodation. There was sufficient equipment at the service. All equipment was serviced regularly, well maintained and available to people who needed to use it.

Staff files contained the information they needed to as well as details of the training they had received. This meant the provider could demonstrate that the staff employed to work at the service were suitable and had the skills and experience needed to support the people who lived there.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). This is where restrictions may be placed on some people to help keep them safe. While no DoLS applications had needed to be submitted, we found that suitable policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

We asked people if they were happy with the support they received. People told us, or indicated through gestures, sounds and facial expressions, that they were happy with their care and felt that their needs had been met. One person replied "Yes".

Our observations and speaking with staff showed that they had a good understanding of people's care and support needs and that they knew them well. This was reflected by the clear guidance in people's care plans and the support staff provided.

Is the service caring?

We asked people who used the service if staff were kind and gentle when they supported them. People indicated that they were. Our observation found that staff knew how to communicate effectively with people. We saw that staff recognised different communications methods used by the people they supported. Care plans contained personalised information which helped staff to know the people they supported and how to meet their needs. We saw that staff showed patience, compassion and understood how to support people as individuals.

Is the service responsive?

People's needs had been assessed before they moved to Jasmine Lodge. This meant that the service had the skills and facilities to meet their identified needs. We saw the people met with their key workers once a month to review what was important to them. People had access to activities that were important to them and had been supported to maintain relationships with friends and relatives where possible.

Is the service well-led?

Staff had a good understanding of their role within the service and felt supported by the manager. The manager showed a good knowledge and oversight of the running of the service. There were quality assurance processes in place to maintain standards in the service. We saw that staff and people who used the service had been given opportunities to express their views.

Throughout the inspection, the manager and staff demonstrated that they placed the needs of the people who lived at Jasmine Lodge at the heart of the service. Discussion with staff found that they had a good understanding of their responsibilities and of the values of the service.

Our examination of care plans showed us that people were supported to make decisions around their lives and families and advocates were involved as appropriate.

Care plans detailed the care and support needed in all areas of people's lives and staff had a good knowledge of each individual's needs and wishes.

There were processes in place to ensure that people's medication was being well managed. A healthcare professional that spoke with us was positive about the care provided. Comments included. 'I have received cooperation with assessments and the implementation of guidelines, I can speak to any of the staff and they have the information I need.'

Staff had received training in protecting people from risk of abuse or harm and there were policies and guidelines in place in order to protect people.

There was a process for investigating and dealing with complaints and concerns.

A family member that spoke with us said. 'I feel the care given to X is outstanding. He has lived in other homes before but now he is really happy and the family would not want him to be anywhere else.'

We found that staff had been made aware of infection control issues and some changes had been made to how soiled laundry was managed. The manager was developing the role of infection control lead to better inform staff. Spot checks and annual monitoring were being implemented but were not yet embedded.

We saw that people had access to all areas of the home. Staff were observed at all times to speak in a respectful and appropriate manner to them. Staff were mindful of people's immediate needs and understood their individual methods of communication. We checked records and spoke with staff to ensure that people's needs were understood and any changes were updated.

We observed people returning to the service from activities and staff said that most people went out every day even for a short period.

Overall we found the premises were well maintained and staff had taken great care to individualise people's bedrooms. However, we found some shortfalls in the way that infection control standards were delivered and monitored. We have issued a minor compliance action for the provider to make improvements.

We spoke with staff and checked records to ensure they had opportunities to develop their knowledge and skills to fulfil their roles.

A Quality monitoring system was in place to ensure that overall a good standard of service delivery was maintained.