This was an unannounced comprehensive inspection that took place on 27 October 2016. At the last inspection completed on 18 February 2016, we found the provider had not met the regulations for; ensuring that staffing levels were sufficient to meet people's needs and ensuring that staff received appropriate supervision and appraisal as necessary to enable them to carry out their duties. At this inspection we found the provider had made the required improvements and the regulations were being met.

The service provided nursing care for up to 66 older people living with dementia and similar health conditions. At the time of our inspection there were 52 people using the service. Most of the people that used the service had advanced levels of dementia.

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 2008 and associated Regulations about how the service is run.

People felt safe living at Jasmine Court. The provider had systems in place for reporting and investigating accidents and incidents. Staff understood what may constitute abuse or avoidable harm to people. They were aware of and practiced the provider’s protocols of reporting incidents of concern.

Risks assessments were in place to manage risks associated with people’s care and support. We saw that these were regularly reviewed and control measures put in place to protect people’s health and welfare.

There were enough staff to meet people’s needs; however, staff were not effectively deployed at meal times. People that used the service, their relatives and the staff that supported them told us that there were enough staff but expressed concerns that the staffing levels about their availability at meal times.

People were supported to have their medicines. Trained nurses supported them with this task. Guidance was not always available or followed to support people who received their medicines covertly or on an ‘as required’ basis.

The provider had an infection control policy. Staff did not always follow this policy.

Staff had access to an effective training and mentoring programme to support them to gain the skills they required to fulfil their role. They received regular guidance from senior staff. They told us that they felt adequately supported in their role.

People’s liberty was not deprived unlawfully. This was because the provider had made applications to the local authority for DoLS authorisation for people that required this. The staff we spoke with demonstrated a good understanding of Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

People received the support that they required to eat and drink. People received the support that they required to meet their health needs. They had prompt access to healthcare services when they needed them.

A public address system was used to pass information to staff. We found this to be loud and startling and did not meet the needs of people living with dementia or similar conditions. The registered manager who told us that they would take action for staff to minimize the use of the system and would look into alternative ways they could disseminate information to staff.

Staff were kind and compassionate to people. Staff that we spoke with demonstrated an interest in the people that used the service and this showed that people mattered to them. People were treated with dignity and respect. Staff provided the support that people needed to be involved in decisions about their care by giving them choices.

People’s care plans were comprehensive. Their relatives were involved in planning their care and support.

We received mixed responses about the support people received to engage in meaningful activities. People had access to acti

Jasmine Court is a nursing home which provides support for up to 66 older people with age related needs, nursing needs and dementia type illness. The service comprised of three floors. We carried out an unannounced comprehensive inspection of this service on 3 and 4 November 2014. After that inspection we received information about concerns in relation to people’s needs not being met due to low staffing levels and lack of staff support. As a result we undertook a focused inspection on 18 February 20016 to look into those concerns.

You can read a summary of our findings from both inspections below.

Comprehensive inspection of 3 and 4 November 2014.

This inspection was unannounced. At our inspection on 17 June 2014 we asked the provider to take action to make improvements. We asked them to improve practices in relation to people’s consent to care and treatment, people’s care and welfare needs, cleanliness and infection control, staffing levels, supporting staff and the systems for assessing and monitoring the quality of the service. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. We found that this action had been completed in our inspection on 3 and 4 November 2014.

People who used the service including relatives we spoke with, made positive comments about the care and treatment provided. We saw staff treated people with dignity and respect and involved them as fully as possible in decisions.

People were supported by staff who had received training on how to protect people from abuse. Safeguarding procedures were in place and appropriate action was taken if concerns were identified. Risk assessments had been completed where appropriate for people who used the service, staff, visitors and the environment. People received their medicines safely and as prescribed by their doctor.

There were sufficient numbers of staff available to meet people’s needs and keep people safe. Staff had the right skills and experience and received an initial induction and on-going training and support. Recruitment practices were safe and relevant checks had been completed before staff commenced work.

People’s human rights were protected because staff were aware of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. This is legislation that sets out the requirements that ensures where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. The home made appropriate and timely referrals to health care professionals and recommendations were followed. Support was also provided for people to attend routine health checks.

People told us that they felt included in discussions and decisions about their care and treatment. Information was available that advised people about independent advocacy services and information about the service including the providers’ complaints procedure. The service provided personalised care and treatment, people had been asked what was important to them in how they wished to be cared for. This information was reflected in their plans of care.

People who used the service, relatives and staff were positive about the leadership and said improvements had been made to the service. The registered manager regularly assessed and monitored the quality of care by completing audits and seeking feedback from people who used the service.

18 February 2016 Focused Inspection into Concerns

Following our inspection of 3 and 4 November 2016, we undertook a focused inspection after receiving information of concern about the service. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

The inspection t

This inspection took place on 3 November 2014 and was unannounced. We also returned announced on the following day to complete our inspection visit.

At the last inspection on 17 June 2014 we asked the provider to take action to make improvements. We asked them to improve practices in relation to people’s consent to care and treatment, people’s care and welfare needs, cleanliness and infection control, staffing levels, supporting staff and the systems for assessing and monitoring the quality of the service. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make. We found that this action had been completed.

Jasmine Court Nursing Home is located in the town of Loughborough Leicestershire. The home provides accommodation and nursing care for up to 66 people who have either nursing or residential care needs. This includes health conditions, physical and sensory needs including dementia. On the days of our visit there were 64 people living at the home. The accommodation is provided over two floors and has a passenger lift.

Jasmine Court Nursing Home has 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.

People who used the service including relatives we spoke with, made positive comments about the care and treatment provided. We saw staff treated people with dignity and respect and involved them as fully as possible in decisions.

People were supported by staff who had received training on how to protect people from abuse. Safeguarding procedures were in place and appropriate action was taken if concerns were identified. Risk assessments had been completed where appropriate for people who used the service, staff, visitors and the environment. People received their medicines safely and as prescribed by their doctor.

There were sufficient numbers of staff available to meet people’s needs and keep people safe. Staff had the right skills and experience and received an initial induction and ongoing training and support. Recruitment practices were safe and relevant checks had been completed before staff commenced work.

People’s human rights were protected because staff were aware of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. This is legislation that sets out the requirements that ensures where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. The home made appropriate and timely referrals to health care professionals and recommendations were followed. Support was also provided for people to attend routine health checks.

People told us that they felt included in discussions and decisions about their care and treatment. Information was available that advised people about independent advocacy services and information about the service including the providers’ complaints procedure. The service provided personalised care and treatment, people had been asked what was important to them in how they wished to be cared for. This information was reflected in their plans of care.

People who used the service, relatives and staff were positive about the leadership and said improvements had been made to the service. The registered manager regularly assessed and monitored the quality of care by completing audits and seeking feedback from people who used the service

Prior to our inspection we reviewed all the information we had received from the provider. Some people that used the service had dementia and therefore were not able to tell us about their experiences. To help us to understand the experiences people had we used our Short Observational Framework for Inspection (SOFI) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us about their experiences and we also spoke with relatives for their views.

During our inspection we spoke with the acting manager, senior manager and five staff. We looked at some of the records held in the service, including the care files for six people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found.

Is the service safe?

Whilst we found the environment in the main clean and hygienic, we identified concerns with the cleanliness of the six kitchens on each of the three floors. These were used to serve people’s meals and provide drinks and snacks.

People had their dependency needs assessed which informed the level of staff required, to meet people’s needs and keep people safe. We found concerns with the staffing levels provided. The staffing levels provided were not sufficient in keeping people safe, meeting individual needs and promoting people’s well-being.

We, the Care Quality Commission (CQC) monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This means that when people have their liberty deprived in order to keep them safe, this was only done following a best interest assessment carried out by the local authority DoLS team. We saw some people had authorisations in place. This showed the provider had acted appropriately and within the legislation.

Is the service effective?

We saw staff communicated with people to gain their consent to care delivery, and used a best interest decision approach. However, we found the provider had not correctly followed the Mental Capacity Act legislation. This meant the provider had not completed the formal process to assess a person’s capacity to consent to a specific decision.

Care records showed that whilst people’s life history, routines, hobbies and interests were recorded, this information was not used to develop a person centred approach to care delivery. Whilst staff were able to demonstrate an understanding of people’s care needs, they did not know about people’s life and social histories.

Whilst staff received appropriate training opportunities, the systems in place to support staff were limited. Staff told us they were satisfied with the training opportunities available to them, but said that they had not received an opportunity to meet with their line manager to discuss their training and development needs. Records looked at confirmed what staff had told us.

Is the service responsive?

The provider had a complaints policy and procedure that supported people to know their rights, and what action to take should they wish to complain about the service. However, relatives we spoke with told us they were not aware of what the procedure was to make a complaint.

We saw that some parts of the environment had been enriched with dementia specific items. For example there was a vintage set of bedroom furniture on one of the corridors, and a seaside theme on another. This provided an opportunity for reminiscence based activities. However, we did not see that people who used the service were supported to explore these environments. Whilst the service had an activity coordinator and we saw records that showed some activities were provided, meaningful activities and stimulation was limited. The lack of activities was a reoccurring concern that relatives had about the service.

Is the service caring?

We found staff were on the whole kind and attentive towards the people they cared for. However, we found the staff lacked direction. The interactions with people were when care delivery was provided. Some people were cared for in bed, we did not see staff provide any social interaction. We saw that some people had additional needs and were supported by a designated member of staff. We found that the one to one time was not used as effectively as it could have been. For example, staff did not use this time to support the person to engage in a meaningful activity.

Is the service well-led?

Staff were aware of their roles and responsibilities. Some staff raised concerns about the leadership and that they did not feel valued or listened to.

We found that the acting manager and senior manager had limited decision making ability. For example, the acting manager told us that the occupancy numbers had increased to full capacity, however the staffing levels had not increased to reflect this. They said a request had been made to increase the staffing levels but a decision had not been made.

We saw the provider had quality assurance processes in place. However, these systems had failed to identify some of the concerns we found. Where the provider was aware of issues and concerns, appropriate action had not been taken in a timely manner to reduce risks to ensure people received an effective and safe service.

People were offered a choice of meals, which met their dietary needs and preferences. One person said, “The meals are much better now.” Meals were prepared at the service by catering staff who were trained to prepare nutritious meals to meet people’s dietary needs.

People told us that they felt safe being supported by the staff. All staff had received safeguarding training and understood the types of concern that may present a risk to the vulnerable people they supported. Staff were well supported, which helped to ensure that people who used the service had their needs met reliably.

People using the service and the relatives of people who used the service told us that staffing numbers had improved. They told us staff on duty responded to their needs and requests in a timely manner. One person said, “I now go out into town with a carer more often.” Staff also told us that they were able to safely support people and spend time doing meaningful activities to promote their wellbeing.

People knew how to make a complaint and were confident to do so. Visiting relatives also told us that they were confident to raise concerns or make a complaint. One relative said, “I have absolutely no concerns. Any little problems that we as a family have raised with the manager, has been addressed quickly.” We found that complaints were all investigated in a timely manner in line with the provider’s complaints procedure and where possible, to the complainant’s satisfaction.

We spoke with people using the service and some visiting relatives. People told us they were treated with respect and their dignity maintained. People said staff were ‘helpful and kind’. A visiting relative said: “I’ve been very happy with the care she gets. Staff seem to know everything about her and can answer my queries even though they may have to refer to her folder for information.”

We observed people using the service who were unable to talk to us. We found staff provided person centred care and support, and maintained people’s dignity at all times.

There were menus now available in formats that were suitable for people to understand. People said they had a choice of meals that met their needs and promoted their health. Individual dietary requirements were met and the meals provided looked balanced and nutritious. People were supported to eat and drink independently because suitable aids and cutlery was provided. Staff supported people to eat and drink in a sensitive manner and maintained their dignity.

The provider had taken steps to ensure there were sufficient numbers of qualified, skilled and experienced staff were employed. People told us they were supported by staff that understood their needs and promoted their safety and welfare.

People’s care records, risk assessments and monitoring reports were sufficiently detailed, kept up to date and stored securely. Staff were aware of their responsibilities to maintain confidentiality and accurate records.

The expert by experience spoke with people who used the service, observed the care and support provided, spoke with visiting relatives and staff. One person said: “I’m happy with the care I get. I only want company, if only staff would come and talk to me.” Comments received indicated people’s care needs were met. However, staff were very task orientated in order to meet people’s care needs, which often compromised people’s dignity, privacy and their human rights. People were not always supported to participate in meaningful activities of interest and improvements were needed.

People using the service had their care needs assessed and care was planned and delivered in accordance with their care plan. There were a range of assessments and reviews in place that ensured people’s health, safety and wellbeing was monitored. People had access to health care support. One person said: “I’m able to see the doctor and the nurse here, which is better for me.” Although people were provided with sufficient amounts to eat and drink, their individual needs were not always taken into account to enable them to eat and drink safely and with dignity.

People who used the service, relatives and staff expressed concerns about the staffing levels. Staffing levels were not consistently maintained and placed people using the service at risk.

People’s care plans and medical records were kept up to date. However, the monitoring records kept in people’s bedrooms were not always kept secure.

We spoke with two people using the service and a visiting relative. They told us they felt the staff looked after people well. One person said they preferred to spend time in their bedroom and were planning to go shopping later that day. The majority of people who live at Jasmine Court Nursing Home were unable to tell us about their experience of the care received because of their cognitive impairment.

People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people’s health and care needs were monitored and reviewed regularly. Medicines prescribed and were administered safely. There were arrangements in place to support people safely and to deal with foreseeable emergencies.

People’s health and care needs were met by qualified nurses and care staff. Staffing levels and skill mix of staff ensured the care needs of people were met safely. Qualified nurses maintained their nurse’s registration to ensure people’s health needs and medicines were administered safely.

We carried out this inspection because we received some information of concern about the management of medicines at Jasmine Court.

We spoke to one person who uses the service about the support with medicines that they received from staff. They told us they are sleeping better and do not wake up with pain at night.

Because many people living at Jasmine Court had some cognitive impairment, we could not ask direct questions about the service they received. People spoken with appeared relaxed and at ease with the staff caring for them.

We carried out this inspection in response to concerns that we received about several aspects of the service.

People received care and support from staff in a manner that was safe and appropriate. Staff helped to maintain people’s dignity; their rights and choices were respected. People’s care needs were assessed and care was planned and delivered in accordance with their care plan. One person told us they were helped every day to get ready and said: “I’m going into town with ….. [staff]”. Records showed people’s needs were met and their health and wellbeing was monitored. People had access to health care support and records showed that doctors and specialist nurses visited people when required.

Relatives told us they were satisfied with the care and support their family members received. One relative said: “We’re happy with the care he gets. I know sometimes, he has to wait for a bit longer because staff are busy, but they know what he’s like.”

We received concerns about the staffing levels and found that the staffing levels were not consistently maintained. Staff we spoke with were committed to looking after people using the service but often felt they were rushed because there was not enough staff on duty. The system in place to source extra staff at short notice was not effective and had the potential of putting people’s health and safety at risk.