We rated Jasmine Court Independent Hospital overall as ‘good’ because:

• Patients and carers told us staff were caring. We observed examples of this during our visit such as supporting patients at lunch to make choices about what to eat. Staff developed ‘hospital passports’ for patients, which gave staff information about the patient, including details of their cultural and family background; events, people and places from their lives; preferences, routines and their personality. Staff promoted sensory stimulation for patients and had developed corridors with themes such as animals, the beach, garden and travel with pictures and objects to help orientate them.

• Staff felt supported by their managers. They told us they were passionate about their work and were motivated. They reported having good morale and feeling valued. The provider had ensured that staff had received appropriate training for their role, including dementia awareness training. Staff received appraisals and supervision to ensure they were competent in their work. The provider had ensured adequate staffing to meet patients’ needs. There were no incidents of nursing shifts being below the numbers established by the provider. There were no nursing staff vacancies.

• Staff completed risk assessments and care plans for patients including for risk of falls and choking. Staff monitored patients for any physical health problems. The provider had some clear and effective systems in place for assessing and monitoring the quality and risks for the service and took actions to address risks as identified. This included senior staff ‘quality first visits’ where they assessed the hospital against a range of standards and identified actions for any improvements.

However:

• The provider did not have a robust process in place for reviewing level one incident documentation to identify when further investigation or actions should take place. The provider had identified that the hospital needed to improve the use of positive behavioural support plans with patients. Managers had identified through audits that staff recording of capacity assessments and best interest decisions for patients still needed improvement.

• The provider had identified that their fire safety assessment needed updating to specifically capture the hospital risks. The provider’s oversight of ligature risk assessment was not robust as during our inspection, staff identified that not all ligature points were captured in their assessment which they took immediate action to address.

• The provider did not give information on how they were considering the workforce race equality standards (WRES) with staff at this hospital.

we rated Jasmine Court as good because

:

• The ward was clean and tidy. The provider kept furniture well maintained. All cleaning records were up to date and completed correctly.
• Staff received regular mandatory training. Staff compliance with mandatory training was 91%. Staff who had outstanding mandatory training had been booked onto courses.
• Staff completed comprehensive and timely assessments of patients upon admission. Staff used this information to formulate patient’s initial care plan.
• Staff received regular supervision and annual appraisals. Supervision rates for staff were 100%. Appraisal rates for staff were 91%.
• Staff were kind, caring and compassionate. They treated patients with dignity and respect. Patients told us that staff were caring and supportive and helped them meet their needs.
• Patients had access to activities seven days a week. The activities coordinator organised activities between Monday and Friday. Nursing staff would do activities with patients at the weekends.
• The provider had good systems in place to monitor staffs compliance with mandatory training, supervision, and appraisals. The manager maintained up-to-date records and monitored these regularly.
• Provider had good systems in place to provide feedback from lessons learnt from incidents and complaints. We reviewed the governance meeting minutes, team meeting minutes, and handover minutes which showed regular discussion on incidents and complaints.

However;

• The provider had not documented best interest decision meetings for three out of the nine patients who lacked capacity. There was no evidence that the provider had discussed the decisions with all those involved in the patient’s care to ensure that they had taken decisions in the patient's best interest.
• The Mental Capacity Act policy was not easily available to staff. The provider was in the process of reviewing the policy and this was waiting to be approved. Senior staff could not easily locate a copy of the policy on the day of inspection.
• Staff had not always given patients a copy of their care plan. We found that three patients had not received a copy of their care plans. Staff had not documented any reasons why they not give patients a copy of their care plan such as refusal or lacking capacity.

We rated Jasmine Court as requires improvement because:

• We found several ligature points (a point that someone can attach a cord to strangle him or herself with) throughout the hospital. Managers had identified these in the ligature audit but the provider had done nothing to reduce the risk to patients.
• One member of staff had not completed the provider’s training before taking part in in restraints (a physical intervention to manage an aggressive patient). Staff did not document restraints as required by the Mental Health Act Code of Practice.
• We observed staff filling in observation records several hours after they had finished observing patients. This meant we could not be sure that records were accurate or that staff had observed patients correctly.
• Managers did not supervise staff monthly, in line with the providers’ policy. Records showed some staff had not been supervised for four months.
• Staff morale was low. Staff felt management did not support them and their concerns were not listened too.

• Medication Administration Sheets (MARS) were not audited appropriately. We found gaps in administration of medications and staff had not written the frequency or amount of medication on the administration chart.

• While regular medication was stored appropriately, controlled drugs were not secure, as the key to the locked control cupboard was kept on the top of the medication cupboard.
• Staff supervision records were not individualised. We found records were the same for several staff, with the only difference being the staff member’s name changed.
• Staff told us they had raised complaints and used the whistle blowing policy but had not received any feedback on outcomes from management.

• At least one member of staff did not have a pinpoint alarm. This meant they would not be able to call for help should they be in a position where they were at risk or needed support quickly.
• Blind spots (areas of the ward that were out of sight) meant that staff could not observe patients on all parts of the ward. Closed circuit television (CCTV) or mirrors were not used to reduce risks.

However:

• Staff completed comprehensive risk assessments.

• Staff treated patients with dignity and respect at all times and respected patients’ privacy.
• Staff were involved in clinical audits and acted on any concerns these highlighted.
• Staff were aware of the organisation’s visions and values and who senior managers were.

We inspected Jasmine Court Independent Hospital on 24 July 2013 because we had received a number of concerns that low staffing levels and staff attitude had led to poor quality care. Further concerns related to there being issues surrounding safety of some vulnerable people and poor management of medicines and complaints. When we inspected the home we found no evidence of poor quality care.

We saw that suitable arrangements had been put in place where necessary to properly assess people’s ability to make decisions in line with published guidance relating to the Mental Capacity Act (MCA) 2005. One relative told us told us, “I am involved in decisions regarding my relative every step of the way.”

We observed that staff treated people with respect and kindness while delivering appropriate levels of care and support. We also saw that care was delivered in a way that met people’s individual needs and welfare requirements.

We saw evidence that medicines were stored and administered safely and reconciled correctly.

Records showed and we saw on the day of our inspection that there was enough staff to ensure people were cared for adequately. One member of staff told us, “Sometimes, I think we’re a bit overstaffed.”

A complaints policy and procedure was in place. We saw that complaints had been replied to in a considered way and in a timely manner.

This inspection took place to check if the provider had made improvements to people's personal records following our last inspection in November 2012.

We did not speak with people using the service as part of this inspection. We visited the service and checked the care records of three people using the service. We found that improvements had been made and that people’s personal records were suitable and fit for purpose.

A number of the people using the service at the time of our visit were older people living with dementia. Some of the people had complex needs which meant they were not able to tell us their views about the hospital. We spent time observing daily life and routines to help us to understand their experiences there. We saw that staff treated people with respect and that people were offered choices. This included in relation to food and drinks, activities and where people chose to spend their time.

We found that some records about people’s care and their rights were not in place or were not accurate. We have told the provider that they must put this right.

We spoke with patients and visitors where this was possible. People told us they were satisfied with the care and support provided at the hospital. One patient said, “Staff are very helpful and caring.” People also spoke positively about the variety and quality of meals provided. They said, “The food is nice here”, or “The food is good.”

We observed staff spending time with people during the visit. Their interactions were respectful and supportive. We also saw that staff monitored people’s health effectively and took actions to promote their wellbeing.

We spoke with two people who use the service. Both said that they can access activities if they wanted to but they don’t wish to do so. However, one person said that they enjoyed doing crosswords and embroidery and that they had opportunity to do this at Jasmine Court. One person said that the advocate had visited the unit and that they had received help from them with regards to their detention. Both people said they would feel comfortable about speaking to staff if they had any concerns.

We spoke with two of the three people who currently use the services at Jasmine Court. They told us they feel comfortable at Jasmine Court, but prefer their own homes and both commented that they were bored on the unit. They said are invited to participate in activities and outings that are run for people in the adjoining care home, but they do not always attend. They said that staff are nice and would put themselves out for them, but both said that one member of staff had been rude to one person on one occasion. They would feel happy talking to staff if they had a problem and they are happy with their medication and receive it on time

We have rated Jasmine Court as good because:

• There were appropriate staffing levels to deliver care. Patients had regular one to one sessions with their named nurse. Leave and activities were rarely cancelled due to staffing levels. The unit manager could increase staffing levels to manage increased levels of observation or activity on the ward. Additional staffing came from a regular bank cohort, this meant patients were familiar with staff and supported continuity of care.
• Patients had their risks assessed and managed. Patient risk assessments were comprehensive and reviewed regularly. Environmental risk assessments were in place. Unit activities had been risk assessed.
• Patients were given a comprehensive assessment in a timely manner. The outcomes of assessments fed into care plans. Care plans and assessments were reviewed regularly in multidisciplinary ward rounds.
• Patient feedback on staff was good. Staff were considered to be kind, caring and supportive. Staff and patient interactions that we witnessed were positive. Staff displayed knowledge of patients and understood their needs.
• Patients had access to a range of activities both within the unit and the wider community. Patients told us they enjoyed the activities available.
• Staff morale was good. The majority of staff were positive about their role and felt supported by management and colleagues. The majority of staff told us there was an open and honest culture and that they would be comfortable raising any concerns.
• The unit used key performance indicators to measure performance. There was a programme of audits to assure quality. Senior management carried out quality assurance visits.

However:

• We found the patient records did not contain a full physical health examination carried out upon admission. However there was evidence of ongoing physical health care.
• Not all staff had received dementia training despite the fact that some patients had a diagnosis of dementia.