This inspection took place on 24 and 25 November 2016 and was unannounced.

Jasmine Court nursing Home is a care home providing accommodation for up to 24 older people some of whom are living with dementia. During our inspection there were 18 people living at the home. The property is set out over four floors and is situated close to the sea front in Weston Super Mare.

The service was last inspected on the 17th September 2015 when it was given an overall rating of 'Requires Improvement.' At that inspection, we found breaches of two Regulations related to consent to care and deprivation of liberty safeguards. We required the provider to make improvements to achieve compliance with these regulations.

The provider sent us an action plan, which detailed the action they planned to take to make the improvements that were required. At this inspection, we found that improvements had been made and legal requirements had been met. The overall rating of the service had improved.

The registered manager had resigned from the home the week before we visited. 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. The provider had already advertised for a replacement manager and was interviewing the following week.

The provider and registered manager from the provider’s sister home, who had been supporting the deputy manager and the staff following the departure of the previous manager, were present throughout the inspection.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Staff confirmed they had been trained in how to identify and report any incidents of abuse they may witness.

Any potential risks to individual people had been identified and appropriately managed. For example, people at risk of pressure wounds had received appropriate nursing care to reduce the risk of their occurrence or recurrence.

People's medicines had been administered and managed safely.

There were sufficient numbers of staff on duty with the necessary skills and experience to meet people's needs.

Staff supported people to eat and drink if required. They ensured people at potential risk received adequate nutrition and hydration.

People were provided with support to access health care services in order to meet their needs.

Positive, caring relationships had been developed with staff to ensure people received the support they needed. They were encouraged to express their views and to be actively involved in making decisions about the support they received to maintain the lifestyle they have chosen.

People and their relatives were encouraged to express their views and make suggestions so they may be used by the provider to make improvements.

The inspection took place on the 17 September 2015 and was unannounced.

We inspected Jasmine Court Nursing Home in September 2014. At that inspection we found the provider to be in breach of regulation 10 assessing and monitoring the quality of service provision and regulation 20 records of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulation 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider wrote to us with an action plan of improvements that would be made. During the latest inspection we saw some of the improvements identified had been made.

Jasmine Court Nursing Home is a care home providing accommodation for up to 24 older people some of whom are living with dementia. During our inspection there were 19 people living at the home. The property is set out over four floors and is situated close to the sea front in Weston Super Mare.

There was a registered manager in post at the service. 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.

We received mixed feedback from people, relatives and staff about staffing levels. Some of the people and relatives we spoke with thought there were not enough staff on shift. Staff told us they were busy and they thought this was because there was a lack of senior staff. The registered manager had recruitment plans in place to employ and train senior staff.

During lunchtime staff appeared rushed and did not always support people in an inclusive way. People and relatives spoke positively about the food provided. People had access to food and drinks throughout the day and where people required specialised diets these were prepared appropriately.

We found people’s rights were not fully protected as the registered manager had not followed correct procedures where people lacked capacity to make decisions for themselves. Deprivation of Liberty Safeguards (DoLS) applications had not been made to the local authority where people were subject to continuous supervision and lacked the option to leave the home without staff supervision.

The registered manager had systems in place to monitor the quality of the service provided. Audits covered a number of different areas such as care plans, infection control and medicines. We found the audits were not always effective at identifying shortfalls in the service.

People and their relatives told us they felt safe at Jasmine Court. Systems were in place to protect people from harm and abuse and staff knew how to follow them. The service had appropriate systems in place to ensure medicines were administered and stored correctly and securely.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service. Staff received training to understand their role and they completed training to ensure the care and support provided to people was safe. New members of staff received an induction which included shadowing experienced staff before working independently. Staff received supervision and told us they felt supported.

People and their relatives told us they were happy with the care they or their relative received at Jasmine Court. One person told us, “The staff are warm, friendly and lovely.”

People’s needs were set out in individual care plans. People and relatives told us they were involved in the care planning process. The care plans were reviewed and updated by the nurses.

People and relatives were confident they could raise concerns or complaints with the registered manager and they would be listened to. The provider had systems in place to collate and review feedback from people and their relatives to gauge their satisfaction and make improvements to the service.

We found 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 this report.

Is the service safe?

Some aspects of the service were not safe and these had not been identified or addressed by the provider.

People were supported by staff who were aware of their responsibilities to safeguard them from harm and to report any concerns.

Where people had identified risks, for example with their skin and falls, we saw that an appropriate assessment had been completed. A plan of support to ensure the person was supported safely by staff had been completed.

The provider operated a safe and appropriate recruitment procedure to help protect people from harm. We saw that appropriate pre-employment checks had been completed.

People were not always protected from the risks of unsafe or inappropriate care and treatment as their records did not always contain accurate and appropriate information.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they intend to make in relation to the record keeping within the home.

Is the service effective?

We saw that the service involved other healthcare professionals as required. People in the home had access to a GP who attended the home a minimum of once a month to see people who required medical assistance. We saw from people’s care records that appropriate referrals had been made to occupational therapists and dieticians when required.

The home had ensured that where a risk had been identified, action had been taken. For example, we saw that when a person’s skin damage had deteriorated, the home had responded to their needs by seeking the appropriate healthcare professional and had followed their guidance.

Is the service caring?

People who lived at Jasmine Court told us their needs were met and told us they felt they received a good standard of care. One person told us, “They staff here look after me, they are very caring.” Another person who chose to spend the day in their room told us, “They (the staff) always come and see me, I never feel alone.”

We spoke with one person who told us they had recently moved into the home. They said the staff had really helped them to adjust to their new lifestyle and surroundings. They told us, “They (the staff) have made sure I’m ok and settled. They will do anything you ask to help you. They are friendly.”

We made observations where people received the support they needed and people told us their needs were met by staff. For example, where people needed hoisting to move from one chair to another, this was done in accordance with the person’s needs.

Is the service responsive?

People told us they were involved in their care planning and decisions about care. We saw that people had been consulted during their care planning and had signed to confirm their involvement. In addition, documents showed that people had discussed their care with healthcare professionals such as an occupational therapist.

People who lived at the home were very complimentary about the staff employed at the home and the care they received. They told us they felt respected as an individual and they told us the staff listened to them. One person told us, “I really feel I’m important to them (the staff).” Another person told us, “I do as I wish all the time here, the staff respect that.” A person’s relative told us, “It seems very homely here, they (the staff) always let us know what’s going on.”

Is the service well led?

Some aspects of the service were not well led and these had not been identified or addressed by the provider.

Staff at the home told us they felt well supported by the registered manager.

We saw that there were systems in place to monitor the quality and safety of the service provided. This included, for example, care reviews with people’s relatives and comment cards to gather the views of the people who lived at the home and their relatives.

There were some suitable auditing system to manage the health, safety and welfare of people living at the home. These audits included the home’s cleanliness and the safety of the environment. However, we found there was no system in operation that monitored the accuracy of people’s care records.

Any accidents and incidents that occurred in the home were recorded and analysed to establish any trends.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they intend to make in relation to the monitoring of record keeping.

At our last inspection in June 2013 we found the home was not meeting the standards for cleanliness and infection control. This visit was to check if the provider had taken the action to ensure people were protected from the risks of acquiring an infection. We also looked to see what the provider had done about the environment following a recommendation made in January 2011.

In June 2013 we identified people were at risk of acquiring an infection because appropriate guidance had not been followed. The bathroom floors did not have an unbroken washable surface to protect people from the risks of infection.

During our inspection we looked at the bathrooms and saw the flooring had been renewed. This meant the provider had taken action to minimise the risks of people acquiring an infection.

In January 2011 we recommended the provider sought to increase the available communal space, as the design and layout meant space was limited when all the people in the home were in the lounge at the same time.

We observed there were people in the lounge who were relaxing and saw there was plenty of space. Four people we spoke with told us they did not feel overcrowded. The provider told us they were progressing plans to increase the communal space.

During the inspection we spoke with seven people who lived in the home; three relatives and five members of staff. We also followed up the issues of concern raised at the last inspection in August 2012 relating to people’s privacy and their involvement in the running of the home.

People who lived in the home told us they were happy with the care and support they received. They told us they were involved in the running of the home through regular meetings.

One person told us, "It is good here, they look after me very well, and they always do things the way I ask them to". Another person told us, "The staff always respect my wishes".

The three relatives we spoke with all told us the care and support provided to their relatives was "wonderful," and "supportive." They said they found the staff approachable, friendly and helpful. We saw staff helped people to their rooms in order to have privacy during visits from relatives.

We observed the member of staff responsible for activities organised meaningful activities to meet individual choices. We saw staff treated people who lived in the home with respect and dignity.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the manager and provider.

The home had quality assurance systems in place which ensured people were safe, and identified changes that could be made to improve the service provided.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practising professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During our visit we spoke with nine people who lived at the home and four staff who worked at the home. We also spoke with relatives who were visiting people at the home. People told us that they liked living at the home and that staff involved them in their care and support. Some people told us that they attended review meetings to discuss their support needs.

Everyone we spoke with told us that the food was very good at the home and that they were given a choice of what they wanted to eat and drink. We were told that snacks and drinks were available throughout the day and observed that staff supported people appropriately with eating and drinking.

People we spoke with told us that they spent most of their time during the day in the home’s lounge watching television. The manager and the staff we spoke with told us that this is what people wanted to do. However people told us that they were unable to go out of the home unless they had relatives to take them, and that there wasn’t a lot going on at the home apart from watching television. Some people told us that a ‘music man’ came to the home on Tuesday and Thursday afternoons. People we spoke with were unsure if they were able to go to their rooms during they day, although three people told us that they thought they would be able to if they asked the staff. They also said that they liked being downstairs in the lounge with the other people.

Everyone we spoke with told us that they felt safe at the home and were aware of how to raise any concerns they had. One person said “if I have some concern then I will tell my daughter to raise it with the matron.” Relatives we spoke with felt confident that action would be taken if they raised a concern with the manager.

We spoke with people who used the service and we met two relatives who were available at the time of our visits to gain their views.

Service users told us that they felt safe at the home and that staff,” Can’t do enough for you”.

People told us that the food was ‘lovely’ and that there was plenty to eat at times that suited them. There was assistance for them to maintain their personal hygiene and that their privacy and dignity was respected. People told us that their rooms were warm and comfortable.

Overall people had positive comments to make about the home and we found that the majority of the essential standards were met. We had some minor concerns about some of the things we noticed when we visited. These were about the level of involvement and activities the service users experience in the home, the level of supervision and support for staff, the systems to keep the home clean and the space available for people.