This was an unannounced inspection that took place on 23 and 24 October 2018.

Jubilee Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides care for up to three people who misuse drugs and alcohol or have mental health issues. It is located in the Morden area of London.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with mental health support needs and autism using the service can live as ordinary a life as any citizen.

The service had 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 and associated Regulations about how the service is run.

At the last inspection in April 2016, the home was rated overall good with a good rating for all five key questions.

The home provided a safe environment to live and work in. There was a welcoming and friendly atmosphere. People said they liked living at the home and were happy there. They were supported to make choices, including a variety of activities at home and in the community. They were comfortable with the way staff provided care and support for them. Throughout our visit there were positive interactions with staff and each other.

The records were up to date and covered each aspect of the care and support provided. People’s care plans were individualised to them and contained regularly reviewed, comprehensive information. This empowered staff to support people efficiently and professionally. People were encouraged to discuss their health needs with staff and had access to GP’s and other community based health care professionals. They were encouraged and supported to choose healthy and balanced diets that also met their likes, dislikes and preferences, whilst protecting them from nutrition and hydration associated risks. They told us they chose what they ate and were happy with the quality of meals provided.

People received constructive support, knew the staff that supported them and staff were fully aware of people’s needs, routines and preferences. Relatives told us that staff worked well as a team. Staff had appropriate skills and provided care and support, within agreed boundaries and in a professional, friendly and supportive way. This was focussed on people and their individual needs. The staff were well trained and made themselves accessible to people and their relatives. Staff told us that the home was a good place to work and they enjoyed working there. They received good training and support.

Relatives said the registered manager and staff were approachable, responsive, encouraged feedback and consistently monitored and assessed the quality of the service.

This unannounced inspection took place on 5 April 2016. At the last inspection on 8 July 2014 the service was meeting the regulations we checked.

Jubilee Lodge provides accommodation for up to three people who require care and support on a daily basis. The home specialises in looking after adults with a learning disability and/or mental health needs. At the time of our visit, there were three people using the service.

The home had a registered manager at the time of the inspection. 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 2008 and associated Regulations about how the service is run.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff understood what constituted abuse and the action they would take to protect people if they had a concern.

Care plans showed that staff assessed the risks to people's health, safety and welfare. Records showed that these assessments included all aspects of a person’s daily life. Where risks were identified, management plans were in place. Records showed that incidents or accidents were thoroughly investigated and actions put in place to help avoid further occurrences. We saw that regular checks of maintenance and service records were conducted.

We observed that there were sufficient numbers of qualified staff to support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it was deemed necessary to restrict their freedom in some way, to protect themselves or others. People at Jubilee Lodge were assessed as capable of making their own decisions and were not restricted in their movements in any way.

Detailed records of the support people received were kept. People had access to healthcare professionals when they needed them. People were supported to cook their own meals and to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew and supported them. Staff knocked on people’s door and waited to be invited in.

People’s needs were assessed and information from these assessments had been used to plan the support they received. People planned their own activities agenda, including work and college opportunities and social events they liked to attend.

The provider had arrangements in place to respond appropriately to people’s concerns and complaints. People told us they felt happy to speak up when necessary. From our discussions with the registered manager and deputy, it was clear they had an understanding of their management role and responsibilities and the provider’s legal obligations with regard to CQC.

The home had policies and procedures in place and these were readily available for staff to refer to when necessary. The provider had systems in place to assess a

During our last inspection of the service on 23 April 2014, we identified essential standards of quality and safety were not being met in respect of Regulations 21 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Following that inspection we asked the provider to take appropriate action to achieve compliance with these regulations. The provider sent us an action plan on 12 June 2014 setting out the steps they would take to achieve this. During this visit we checked these actions had been completed. We also checked whether previously identified improvement actions, which were needed to maintain compliance, had been taken.

This visit was carried out by an inspector who helped answer three of our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, from looking at records and from speaking with the home’s manager. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found at this visit the provider had ensured appropriate checks had been undertaken of staff employed by the service to ensure they were of good character and had the necessary qualifications, skills and experience to care for people using the service. Where the provider had been unable to obtain satisfactory references for staff, they ensured they were not able to work at the service until these were received. We saw new recruitment processes had been introduced to ensure that appropriate checks were undertaken by managers before people were able to start work at the home. We also saw there were enough staff to meet the needs of people using the service.

The home’s manager was the dedicated lead for infection control which gave assurance that risks to people of exposure to infection were effectively assessed, monitored and managed.

Is the service effective?

We looked at staff records and found staff received training and supervision meetings to support them in their roles, so people could be assured their needs were being met by appropriately skilled and trained staff.

Is the service well-led?

The provider had used the findings from our last inspection of the service to review and subsequently update their recruitment processes. This gave them assurance people should not be put at risk of receiving unsafe and inappropriate care from staff who were not able or suitable to provide this.

We saw regular checks were undertaken and documented by the home’s manager, to review the quality of care and support provided by staff.

Jubilee Lodge is a residential care home providing mental health support for up to three people. At the time of our visit, one person was using the service and three staff were employed to care for them. We spoke with the person using the service and their relative. We advised both people that there being only one person using the service meant that they could be identified from their comments in this report. Both people indicated that they understood this and gave permission for their comments to be used. We also spoke with the manager of the service and two of the three care staff.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were protected from the risks of unsafe premises because the home was clean, tidy and well-maintained with daily health and safety checklists completed. Appropriate arrangements were in place with regard to the obtaining, storage, administration and recording of medicines. This gave people protection from the risk of unsafe medication.

People could be placed at risk because staff did not have adequate training in how to deal with medical emergencies, although they were aware of procedures. Safe recruitment procedures were not in place as staff were allowed to work alone with people who used the service before references or other evidence of good character had been received. We have asked the provider to make improvements to the recruitment practices of the service to ensure only suitable staff were recruited to work with people using the service.

Risk assessments and risk management plans were in place, although some risks that had been identified were not followed up with specific management plans to ensure those risks were minimised as far as was possible. Staff were aware of these risks and knew how to protect people from them, so we were satisfied that people were safe. However, people were still potentially at risk of unsafe care from new staff or other providers that may be involved in their care and would not be aware of measures to reduce specific risks.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place and people were free to leave the home as they pleased. People told us they felt safe and said “I can go out when I want.”

Is the service effective?

The service used certain approaches and methods designed to support people with mental health needs. Staff were not aware that these approaches were being used and told us they had not yet received specific training about mental health awareness and other specialist training. This may mean that people were not always receiving effective care. However, the manager confirmed the training was planned and staff knew about the principles of person-centred care and promoting independence that were central to the approach used. There were clear recovery goals in place for people using the service, although plans of how to achieve these were unclear.

There was evidence of access to other health professionals when required and adequate healthcare records were maintained. The person who used the service felt that their needs were met and their relative told us staff were “doing the best they can.”

Is the service caring?

The person using the service and their relative confirmed that they had involvement in planning care. The person told us, “I get to choose things like how to have my food” and said they would like to try more new activities.

We observed that staff respected the dignity, privacy and independence of the person, for example by enabling them to get up at a time of their choosing and attend to their own personal care.

Care plans took into account the person’s cultural background, wishes and goals. Records of care showed that care was delivered in line with the care plan. Appropriate support was given for the person to attend medical and other appointments.

Is the service responsive to people’s needs?

The service had carried out an assessment of needs before the person commenced using the service. The person’s relative said staff had a “very good understanding” of their family member’s needs. We saw several examples of how the service had adapted to meet their needs, for example by taking their cultural background into consideration when suggesting meal plans and by recording their informal feedback and following up with actions.

Is the service well led?

Staff told us they were always happy to raise concerns with managers, but they did not yet receive supervision and there was no formal supervision policy. Managers had planned supervision dates and provided support to staff through visits and telephone calls, but new staff had been left for periods of several days or nights working alone without formal support from managers. We have asked the provider to make improvements to the supervision and training of staff to ensure staff are adequately supported to carry out their roles safely and appropriately.

Managers carried out a number of checks to monitor the quality of the service, although these were not all recorded. We saw that they regularly visited the home. The person who used the service and their relative confirmed that their views were sought and acted on.

‘I like it here’, ‘very nice – I like the home and the staff’ and ‘I feel at ease’ were comments from the people who use the service.

Feedback about the staff who support people living at Jubilee lodge included ‘I can talk to staff about things’ and ‘they have a good manner’.

Individuals told us that they were able to do the shopping and cook for themselves. One person said that were able to do the thing s they liked to do such as watching TV, going to Sutton shopping or to the cinema.

Issues raised by people included getting a better understanding of their rights whilst living at the service and being able to have a front door key.