We inspected Jasmine Lodge on the 8 and 9 November 2016. Jasmine Lodge provides accommodation and support for up to six people. Accommodation is provided from a building which was purpose built as a care facility for people with learning disabilities. The building is located within a residential area.

The service provides care and support to people living with a range of learning disabilities and longer term complex healthcare needs such as epilepsy. Most people living at Jasmine Lodge were unable to communicate with us verbally. People had been living at the service for between six to 17 years. There were six people living at the service on the day of our inspection.

We last inspected the service on 26 June 2014 where we found it to be compliant with all areas inspected.

A registered manager was in post. 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 and associated Regulations about how the service is run. The registered manager managed Jasmine Lodge and another service for the provider.

Although staff spoke positively regarding the leadership of the service, we found some issues with records and quality assurances systems which were not consistently providing senior staff with clear oversight of all areas of the service. The registered manager was responsive to our feedback and took corrective actions.

Medicines were managed safely in accordance with current regulations and guidance. There were systems to ensure medicines had been ordered, stored and administered, appropriately.

People appeared happy and relaxed with staff. There were sufficient staff to support them. Checks were undertaken to ensure staff were suitable to work within the care sector. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. A range of specialist training was provided to ensure care staff were able to meet people’s needs.

It was evident staff had spent time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. Areas included eating, falls and seizures. People consistently received the care they required because staff were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

People were provided with opportunities to take part in a range of activities and hobbies and to regularly access the local and wider area. People were supported to take an active role in decision making regarding their own routines and the routines and flow of their home.

Staff had a clear understanding of the vision and philosophy of the home and they spoke enthusiastically about working at Jasmine Lodge and positively about senior staff. Regular quality assurance reviews to monitor the standard of the service were completed internally and by the provider’s operations manager.

Our inspection team was made up of one adult social care inspector. We set out to answer our five key 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 describes what people using the service and staff told us, our observations during the inspection and the records we looked at. At this inspection, we spoke with all of the people who lived at the service, three care staff and the manager.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that care plans were sufficiently detailed to allow staff to deliver safe and effective care that reflected the support required in people’s assessed needs.

People lived in purpose built, safe and well maintained accommodation. There was sufficient equipment at the service. All equipment was serviced regularly, well maintained and available to people who needed to use it.

Staff files contained the information they needed to as well as details of the training they had received. This meant the provider could demonstrate that the staff employed to work at the service were suitable and had the skills and experience needed to support the people who lived there.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). This is where restrictions may be placed on some people to help keep them safe. While no DoLS applications had needed to be submitted, we found that suitable policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

We asked people if they were happy with the support they received. People told us, or indicated through gestures, sounds and facial expressions, that they were happy with their care and felt that their needs had been met. One person replied "Yes".

Our observations and speaking with staff showed that they had a good understanding of people’s care and support needs and that they knew them well. This was reflected by the clear guidance in people’s care plans and the support staff provided.

Is the service caring?

We asked people who used the service if staff were kind and gentle when they supported them. People indicated that they were. Our observation found that staff knew how to communicate effectively with people. We saw that staff recognised different communications methods used by the people they supported. Care plans contained personalised information which helped staff to know the people they supported and how to meet their needs. We saw that staff showed patience, compassion and understood how to support people as individuals.

Is the service responsive?

People’s needs had been assessed before they moved to Jasmine Lodge. This meant that the service had the skills and facilities to meet their identified needs. We saw the people met with their key workers once a month to review what was important to them. People had access to activities that were important to them and had been supported to maintain relationships with friends and relatives where possible.

Is the service well-led?

Staff had a good understanding of their role within the service and felt supported by the manager. The manager showed a good knowledge and oversight of the running of the service. There were quality assurance processes in place to maintain standards in the service. We saw that staff and people who used the service had been given opportunities to express their views.

Throughout the inspection, the manager and staff demonstrated that they placed the needs of the people who lived at Jasmine Lodge at the heart of the service. Discussion with staff found that they had a good understanding of their responsibilities and of the values of the service.

We used a number of different methods to help us understand the experiences of people who used the service, because the people who used the service had complex needs and did not communicate verbally with us. We observed positive interactions between people and the staff supporting them. Staff were friendly and supportive and there was a calm atmosphere in the home.

Our examination of care plans showed us that people were supported to make decisions around their lives and families and advocates were involved as appropriate.

Care plans detailed the care and support needed in all areas of people’s lives and staff had a good knowledge of each individual’s needs and wishes.

There were processes in place to ensure that people’s medication was being well managed. A healthcare professional that spoke with us was positive about the care provided. Comments included. “I have received cooperation with assessments and the implementation of guidelines, I can speak to any of the staff and they have the information I need.”

Staff had received training in protecting people from risk of abuse or harm and there were policies and guidelines in place in order to protect people.

There was a process for investigating and dealing with complaints and concerns.

A family member that spoke with us said. “I feel the care given to X is outstanding. He has lived in other homes before but now he is really happy and the family would not want him to be anywhere else.”

We visited to review compliance against a previous minor concern about standards of cleanliness and monitoring of this. We checked all areas of the home and we spoke with a staff member and the manager. People living in the home had complex needs and communication difficulties and were unable to comment about this outcome.

We found that staff had been made aware of infection control issues and some changes had been made to how soiled laundry was managed. The manager was developing the role of infection control lead to better inform staff. Spot checks and annual monitoring were being implemented but were not yet embedded.

When we visited we met with five staff, the manager and four of the people who lived in the service. We used a number of different methods to help us understand the experiences of the people using the service, because they had complex needs which meant they were unable to tell us their experiences.

We saw that people had access to all areas of the home. Staff were observed at all times to speak in a respectful and appropriate manner to them. Staff were mindful of people’s immediate needs and understood their individual methods of communication. We checked records and spoke with staff to ensure that people’s needs were understood and any changes were updated.

We observed people returning to the service from activities and staff said that most people went out every day even for a short period.

Overall we found the premises were well maintained and staff had taken great care to individualise people’s bedrooms. However, we found some shortfalls in the way that infection control standards were delivered and monitored. We have issued a minor compliance action for the provider to make improvements.

We spoke with staff and checked records to ensure they had opportunities to develop their knowledge and skills to fulfil their roles.

A Quality monitoring system was in place to ensure that overall a good standard of service delivery was maintained.