living with dementia. Accommodation is arranged over two floors; people living with more advanced dementia were typically accommodated on the first floor, whilst the ground floor was used to accommodate those people with higher physical needs.

The inspection took place on 7 June 2017 and was unannounced. There were 37 people using the service at the time of our inspection.

The registered manager was present during our inspection. 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 registered manager had been in post since November 2015.

We previously carried out an unannounced comprehensive inspection of this service on 4 April 2016. At that inspection the service was rated Requires Improvement and 4 recommendations were made to encourage improvements to the way the service was delivered. Immediately following that inspection, the provider sent us an action plan which identified the steps they had taken and would continue to take to ensure improvements were made. This inspection found that the provider had not only done the things they told us they had, but also continued to develop and improve the service to not only meet the fundamental standards, but in some areas exceed them too.

Jubilee House was well-led with good systems in place to provide support that was safe, effective, caring and responsive. Management and staff consistently went the extra mile to ensure people led meaningful and fulfilling lives.

Staff treated people with kindness and took steps to promote their privacy and dignity at all times. Support was provided with compassion and wherever possible people’s independence was promoted.

End of life care was exceptional with the service consistently planning for and meeting people’s final wishes and ensuring their final days were lived comfortably surrounded by the people who knew and cared for them.

People were cared for by staff who were well trained and knowledgeable to meet their individual needs. Appropriate checks were undertaken when recruiting new staff to ensure only suitable staff were employed.

The service had good systems to identify and manage risks to people and to maintain the safety of the service as a whole. People were protected from the risk of abuse or avoidable harm, because staff understood their role in safeguarding them.

Wherever possible, staff supported people to make decisions for themselves. In situations, where this was not possible, appropriate processes had been followed to ensure any decision made was within their best interests and that care was provided in the least restrictive way.

Staff worked in partnership with other health care professionals to help keep people healthy and well. There were good systems in place to ensure people received their medicines as prescribed.

The registered manager had taken proactive steps to ensure people received appropriate nutrition and hydration. Mealtimes were a sociable occasion and people had a plentiful supply of good quality meals.

Each person was appropriately assessed and had an individualised plan of care which outlined how their needs would be met. People were involved at each stage of planning their care to ensure staff provided support in a way that met their needs, preferences and expectations.

People had control over their lives and spent their time as they wished. The service offered a wide range of both group and individual activities that were meaningful to them and which had a positive impact on their lives. Visiting was unrestricted and people’s relatives felt included in the care of their loved ones.

The leadership team had fostered a positive and open culture where people, their representatives and staff were encou

This unannounced inspection was carried out on 4 April 2016. Jubilee House provides nursing care for people who are living with dementia and some who have a mental health diagnosis. It is registered to accommodate up to 48 people. On the day of our inspection 37 people lived at the service. The accommodation is arranged over two floors. The upstairs floor accommodates people who are living with more advanced dementia. People downstairs have more physical needs.

There was a registered manager in place who was present on the day of the inspection. 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 always enough staff deployed around the service to consistently meet people’s needs. People sometimes waited long periods of time before they received support from staff particularly around meal times.

There were areas around the service that required cleaning including one of the medicine rooms and one of the sluice rooms. Other areas of the service were clean and well maintained.

There were not always effective systems in place to assess and monitor the quality of the service. Audits had not always identified areas that required improvements. However other audits and surveys had been undertaken with people, relatives and staff but had been used to improve the quality of care for people. Records were not always stored appropriately or easy to access.

People’s medicines were administered and stored safely. Risks had been assessed and managed appropriately to keep people safe which included the environment. The risk assessments for people were detailed and informative and included measures that had been introduced to reduce the risk of harm. In the event of an emergency, such as the building being flooded or a fire, there was a service contingency plan which detailed what staff needed to do to protect people and make them safe.

Accidents and incidents with people were recorded electronically with a written copy kept in a file. Staff had knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse. Staff had undergone recruitment checks before they started work. People said that they felt safe.

People’s rights were protected under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring that people were consenting to their care. This also ensured that where restrictions to people’s freedom and liberty had been undertaken, these had been authorised by the local authority.

People were not always cared for by staff who had received appropriate training and knowledge specific to the needs of people who lived at the service. However all staff were kept up to date with the mandatory training including moving and handling and health and safety. Staff did provide good care to people on the day of the inspection.

Staff were supported in their work and said that they had regular supervision with their manager. There were opportunities for staff and their manager to discuss their performance.

The building met the needs of the people that were living there in particularly those who were living with dementia. There were destination points and signage to help orientate people around the service and assist with their independence.

Nutritional assessments were carried out when people moved into the home which identified if people had specialist dietary needs. People had access to a range of health care professionals, such as the GP, dietician and podiatrist.

Staff at the service were caring and supportive and staff treated people with dignity and respect. People told us they were involved in planning their care. Ca

This was a follow up visit to check that the provider had achieved compliance with cleanliness and infection control following our previous inspection in July. During this inspection we looked at this one non compliant outcome. We spoke with a number of people, however due to their communication difficulties they could not provide us with meaningful feedback about their experiences. We did speak with some relatives and they told us the home was clean and fresh.

We found considerable improvements had been made in the cleanliness and the environment was a much more pleasant place for people to spend their time.

Many of the people at Jubilee House were unable to tell us about their experiences in a meaningful way. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool.

"SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us."

People were treated respectfully and their views were taken in to account by staff.

People who could communicate with us in a meaningful way told us staff were caring. Relatives spoken with told us their family members "were always asked for their consent and were treated with dignity and respect".

Risks to people's health and welfare were assessed and care was planned and delivered according to people's needs. One relative told us "I think this is a great home, staff are very attentive and they could not care for my husband any more than they do."

People were encouraged and supported with their meals and they appeared to enjoy the meal time, one person said "The food at the home is good."

Some infection control practices at the home were poor.

People's health and welfare needs were met by sufficient staff that had been properly vetted and were fit to work at the home.

People’s complaints were listened to and dealt with appropriately.

A number of the people at Jubilee House had dementia and were unable able to tell us about their experiences. To help us to understand the experiences of people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences. We spent a considerable amount of time observing care and found that people had positive experiences.

We observed the manager on a number of occasions during the day interacting with the people living at the home. These observations showed us she knew the people well and had a good understanding of their needs and they responded positively to her. We also observed staff interacting with people throughout the inspection and heard them speak with people respectfully and seek people's views regarding day to day life in the home.

Relatives spoken with were very positive about the quality of care at the home, for example " it such a lovely place, my Mum is safe and well cared for", "staff always keep me informed about my Mum's care needs and if anything changes", "I am invited in to various activities going on at the home" and " the staff are lovely, always polite and couteous", " I am so relived my Dad is in such safe hands.

We did not, on this occasion speak to people so cannot report what the people using the service said.

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.