The inspection visit took place on 10 August 2017 and was unannounced. The previous comprehensive inspection was carried out on 17 March 2015. At that time the service was meeting the requirements of regulations.

At the previous inspection we found the registered manager and staff were not trained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They did not understand its potential impact on their practice. This had been recognised by the registered manager who was seeking the necessary training. Since that inspection action had been taken to ensure all staff had undertaken training and understood what restrictive practice meant and what action to take. The current manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Jubilee House provides residential care for up to 28 older people some of whom were living with dementia. The service is also registered to provide nursing care, however nursing care was not being provided and the manager said it was not the intention of the service to admit people who required nursing care. The manager told us the provider is continuing to review whether a nursing category is to be retained for this service. At the time of the inspection there were 26 people living at the service.

The service is situated within a residential area of Torquay, close to the town centre and transport network. Car parking is available at the front of the service on a private forecourt. There are two floors serviced by a passenger lift. There were a range of aids and adaptations suitable to support the needs of people using the service. There was an external garden area suitable for people to use.

The service is required to have 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. The manager had submitted an application to register with the Care Quality Commission (CQC) at the time of the inspection.

People and relatives all spoke positively about the service. Relatives told us that people were safe living at the service and that staff were kind, friendly and treated people well. They told us that the manager was always available and approachable. Comments included, “Can’t praise the staff enough,” “They (staff) are very good at sorting things out for me when I get a little muddled” and “The support and care from the team is excellent.”

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse. Accidents and Incidents were logged, investigated and action taken to keep people safe. Risk assessments were in place which were individualised for the person. This was to minimise potential risk of harm to people during the delivery of their care and support. Risk assessments were regularly updated and changes made as necessary so staff were responding to current risk levels.

The service had clear pictorial signage to meet the needs of people living with dementia. This helped people to recognise their rooms and orientate themselves around the building. The service was well maintained and clean. There were no incontinence odours at the service. People’s bedrooms were well decorated and personalised to give them a familiar feel. One person told us they loved the fact they had personal items around them including specific items of furniture and ornam

This was a planned inspection. We also looked into information received prior to the inspection. This information alleged rudeness by the management towards residents and staff and a lack of medication training. On 11 November 2013 we found no evidence to support these allegations.

We spoke with eight people who lived at Jubilee House and four relatives. We also spoke with six staff and four visiting health professionals. One person said "The manager and the staff here are absolutely lovely.” People told us they were happy with the care and support they received. We observed that staff treated people with respect and protected their dignity.

Staff knocked on people’s doors and asked for permission to enter. We observed that people were supported at meal times and their independence was promoted. We looked at all areas of the home including bathrooms, toilets, bedrooms and communal areas. We saw warm and friendly interactions between management, staff and people who lived at the home.

We found that medication was being managed well and was stored securely at the home. Appropriate and accurate medication administration records were kept.

Staff were supported to carry out their roles by the management. One said “The manager listens to our opinions and is always polite and courteous.”

We saw that the home maintained appropriate and robust audit systems to monitor the quality of care.

People’s privacy, dignity and independence were respected. One person using the service told us “this is a very pleasant place to be, all the staff are very nice.” Another person told us “the staff are very good with people, they always listen to what I have to say.”

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were enough qualified, skilled and experienced staff to meet people’s needs. One visiting relative told us “There are always staff available for mum.”

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. People’s personal records were accurate, fit for purpose and contained sufficient detail.

We (The Care Quality Commission) brought forward a review we had planned of Jubilee house because we received some concerns about the service. The concerns related to staff being under pressure and stressed, which was affecting the way they cared for and interacted with people. This was said to be because the home was understaffed. We were also told that people ringing call bells were waiting a long time before they were answered. Sometimes we were told staff were leaving call bells out of reach, or turning them off and going away without attending to the individual. We were told the food was insufficient and of poor quality so peoples choices were not being respected. And we were told that the records regarding food intake were not being completed in sufficient detail.

On our inspection we spoke with seven people receiving care and also spoke with a family member who was visiting. We also observed care being delivered to other people living at the home, most of whom had some degree of memory loss.

We found some of the concerns we had received were substantiated, in particular staffing shortfalls and poor record keeping. Other areas such as the standard of the food being served had already been the subject of action by the home. Some areas, such as staff not responding to bells we could not substantiate. Prior to our inspection, we had been told that some of the staff had been 'short' with individuals living there. This was said to be because they were very pressured and stressed. We asked people living at the home if they had experienced this. One person told us that staff could be quite sharp at times.

People that we spoke with overall told us that they were happy with the quality of the services provided. People told us "I'm very happy here. I couldn't wish for anything better" and "they are kind to us here. They are nice girls and boys. The only bad thing is the weather". One person told us they felt isolated. They said "I try to talk to people and they don't want to know me".

Two people told us that they would like to do more things, including trips out. We were told that there were activities provided at the home on Wednesday and Friday mornings. On the day of the inspection there was a visiting musician, who then carried out a discussion group with people using the service. There was no information recorded on activities people might like to carry out individually and how this could be supported within their care plans.

We observed people interacting well with staff who were positive and cheerful, despite being very busy throughout the visit. Staff mostly knocked on people's doors and waited for an answer before going into the room, however this was not always the case.

Consistently people told us the home was short of staff. We spoke to seven individuals, six of whom told us there were not enough staff to provide the care that was needed. People said "definitely short of staff" and "they are all very good but there are not enough of them". One more person said "most of the staff are very nice. I have been in here just over a year. They are underpaid and overworked I feel sorry for a lot of them. I don't think you'd get anything much better anywhere else". During our visit staffing levels were increased.

We found that the care records did not reflect people's choices or wishes regarding their care needs. People told us they had not been involved in drawing them up or reviewing the plans. We spoke with one individual who had specific health needs. They told us the the staff understood their needs clearly. They felt the staff had the knowledge to assess when their condition was deteriorating and call for medical support.

We also found that people's medication was not always being kept securely or handled safely.

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

Jubilee House provides care without nursing for up to 28 older people who may be living with dementia. The home is registered for nursing care however nursing was not being offered. The registered manager is currently reviewing whether this is necessary to the service. There were 27 people living at the service at the time of the inspection however, one person was in hospital.

A registered manager was in post. 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.

People told us they were happy and safe living at Jubilee House. They told us they were well cared for by the staff at the service. People told us they felt comfortable sharing their concerns with staff. They added the registered manager, deputy manager and all staff would always answer their questions and keep them safe. Visitors also told us their loved ones were safe and well cared for at Jubilee House.

We observed staff and people were comfortable in each other’s company. There was a happy, relaxed atmosphere and lots of appropriate humour between staff and people. People were observed moving around the home freely and interacting with each other. People acted in a supportive and caring way to each other. Staff and the registered manager demonstrated they understood the importance of ensuring people were treated with dignity and respect. They also ensured people’s consent was sought before care commenced.

The registered manager and staff were not trained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards . They did not understand its potential impact on their practice. However arranging the training was in progress. No one was currently being deprived of their liberty. One person was having their medicines given covertly. No assessment or best interest decision was recorded as to whether the person lacked the capacity to consent or was choosing to not consent to that medicine being taken. The registered manager agreed to ensure this was followed up with the person’s GP.

Staff were recruited safely and trained to meet people’s individual needs. Staff demonstrated they were able to keep people safe by being able to identify abuse and following local safeguarding policies. Staff also told us they would share their concerns with the registered manager or deputy manager. They felt these would be acted on and addressed quickly.

People had their medicines administered safely and as prescribed. Careful records were kept of this. There were regular internal and external audits to ensure it remained safe. Any issues were quickly addressed. Only staff trained to administered medicines did so and they had their competency monitored at regular intervals.

People had care plans in place which reflected their current needs and they were involved in planning their care and how staff should meet their needs. Where required risk assessments were completed to support people to take informed risks and remain as independent as possible for as long as they could.

People’s nutritional and health needs were being met. People could see their GP as required. Other health professionals such as dieticians were involved in assessing and planning people’s care as required. Where assessments detailed how staff should meet people’s needs these were carefully followed and recorded. Staff also took time to explain these assessments to people so they understood them.

People knew about the complaints policy. They felt they could raise concerns and these would be dealt with. People were not always happy about the quality of the food but we could see from recent questionnaires that this was being addressed.