The inspection took place on 14 September 2016 and was unannounced.

The service was previously inspected on 3 July 2014 when it was found to be fully compliant with the regulations in force at that time.

The Fire Fighters Charity is a national Charity providing assistance to serving and retired members of the fire and rescue service community, as well as eligible dependants. The Charity aims to enhance quality of life and make a positive difference to the lives of people who use their services.

The Fire Fighters Charity operates Jubilee House Therapy Centre which is a purpose built rehabilitation and therapy centre, situated near to Penrith. This facility provides a bespoke service to people in the fire and rescue community.

People who used this service did not permanently reside at Jubilee House. The four beds registered with the Care Quality Commission were used to accommodate people who required nursing input during their planned programme of rehabilitation and therapy. The registered beds were located on the ground floor in large, ensuite rooms which enabled people with a wide range of needs to be accommodated.

There is a registered manager 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.

During our inspection of this service we saw, and people told us, that they were well supported and cared for. Comments from the people who used this service included; “The staff here always check with me at each visit, what I need and how much help I would like. I am respected here.” And “I am very lucky to have access to this service. The staff are brilliant and the facilities are excellent. It’s truly marvellous and I would live here if I could.”

All the people who used this service, who we spoke to, commented on the way in which staff respected their individual needs and choices. No one could "fault" the service in any area.

We reviewed the care and support records of people who were using the service at the time of our inspection. We checked this information with people who used this service during our discussions with them and found that the information was accurate and up to date. We found that care and support was tailored and personalised to meet each person’s needs and aspirations.

We spoke to two members of staff who were working in the nursing unit at the time of our inspection. They told us that they liked "the management style” at the service. They said that the management team were “supportive and approachable.” Staff told us that they regularly met with their manager and that they were provided with suitable training to help them keep their skills and knowledge up to date. We reviewed staff training and supervision records during the inspection, which verified what we had been told by the staff and the manager at the service.

The premises were well maintained, clean and fresh smelling. There were extensive policies and procedures in place and staff understood their roles with regards to infection control and prevention.

Maintenance records kept at the service showed that the premises and the equipment were regularly serviced. There were risk assessments in place, which included emergency and contingency plans should the service need to be evacuated.

People who used the service told us they were well supported with their nutritional and hydration needs, including special diets such as weight reducing diets or vegetarian diets. People were able to choose what they wanted for their meals. Everyone that we spoke to was very complimentary and satisfied with the standard of food and drink available.

We observed that staff showed concern for people in a caring way. Staff approached people in a friendly manner, provi

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found -

Is the service safe?

We found that people had detailed assessments and plans regarding their care and how this would be provided. The records included risk assessments, which showed that strategies had been put in place to help staff work with, and support people safely, whilst encouraging their independence.

The people we spoke with told us that they had never had to raise a complaint or concern about the service or any of the staff. However, they were aware of who to speak to should the need ever arise.

We looked at the records maintained by the service with regard to compliments, complaints, accidents and injuries.

We found that no complaints had been raised but there were many examples of compliments and service user satisfaction comments.

The accident and incident records had been monitored and audited. Information from these records had been included in the health and safety audit for the service.

Is the service effective?

The people we spoke to during our visit to this service told us of the treatment programmes they received whilst at Jubilee House. They told us that their treatment had been designed around their needs and took into consideration their lifestyle once they returned to their own homes.

One person told us, “The treatment I receive here is built around not only what I need here but also what I will need when I go home in order to remain independent. They (staff) adjust my treatment plans to meet my needs.”

Is the service caring?

People who used this service were placed at the centre of their care, treatment and support. We found that people were encouraged and enabled to make decisions about the care and support they received during their stay at Jubilee House.

We spoke with staff during our visit to the service and we observed them working with some of the people that used this service. We judged that staff respected and promoted people’s privacy, dignity and independence.

People who used this service told us of their satisfaction regarding the care and support they received at Jubilee House. They commented:

“The care and attention I get from this place is fantastic. It should be part of the NHS so that everyone could experience such great care.”

“Staff discuss my care with me. They are very helpful and very patient.”

“The staff are very nice and very kind. They discuss my support and treatment plans with me. The treatments are built around my needs and wishes.”

Is the service responsive?

The sample of care plans we looked at showed that people who used this service had received an assessment of their care and support needs before they stayed at Jubilee House. The people we spoke to during our visit told us that they had been fully involved in the process and had been able to discuss their needs and expectations.

One person particularly referred to this aspect of the admission process and told us; “I was asked about my care and support needs before I came to Jubilee House. There were lots of discussions about my requirements.”

Is the service well led?

We found that there had been some changes to the management of the organisation and within the service, since our last visit to Jubilee House. A new registered manager was in post at Jubilee House and she told us of some of the changes and improvements that had been made.

There was evidence to demonstrate that a robust system of quality assurance and monitoring was in place. This included service user satisfaction surveys, staff training and development.

One of the members of staff that we spoke to told us, “We have a proactive manager. She listens and acts on what is said. People’s views are listened to and taken on board.”

The people we spoke to during our visit to Jubilee House were very pleased with the service and treatment they received. We found that people had been involved right from the start with the development of their care and treatment plans. We found that people were able to choose the level and type of support they wanted and that this helped them to maintain their independence, privacy and dignity.

We found that the provider had improved the way they checked and monitored the quality of the service. Policies and procedures had been updated and care records were more detailed. We saw that staff training had been undertaken. However, there were shortfalls in the way staff are supported in their work and we have asked the provider to address these.

We received the following comments from people who used this service:

"This place is marvellous, it's great and they help me a lot - it's a god send. The staff are very helpful and I improve everytime I come here. You couldn't get better treatment anywhere. The staff cannot do enough and they remember you at every visit. It's an uplifting place, everyone is always smiling."

"It's like coming home here but better. There's always a feeling of warmth and friendliness. I'm really well looked after, the staff are very careful when they are supporting me with my personal care. People always have time for you. They discussed with me what I wanted to get out of my time here and then tailored a personal programme of treatment for me."

People told us that they felt ‘included in everything’ to do with their care and support needs. One person said; “staff regularly check that I am OK and if I need anything”. They also told us that; “staff always explain what is going to happen and what we are going to do next”. This was with regard to their care and support programme.

People told us of the information they had supplied to the service prior to their admission and that this had helped to ensure the staff were aware of all their individual needs and preferences.

Staff were described as “very caring” and “brilliant”. Comments from people included; “nothing is too much trouble” and “the staff get what I want and do what I need them to. They know my needs well”.

One person told us that they thought the staff were “very competent and caring.” Another person said that they felt “confident in the capabilities of the staff”.

We found that people were happy with the care and support provided, but when we asked them about their plans of care they were unsure of whether they had such a document.

The general environment was clean and tidy with arrangements in place for the disposal of waste and contaminated items to help reduce the risks of cross infection.

We found that staff had participated in some training to help them carry out their role safely and effectively. We did not see any evidence of training plans and records of training already undertaken were not maintained and up to date.