About the service: Jubilee Gardens accommodates up to 50 people in one adapted building. The home has two floors. It provides residential and nursing care to older people who live with dementia. During our visit 39 people lived at the home. The home is located in Castle Bromwich, West Midlands.

People's experience of using this service:

• People felt safe and were protected from avoidable harm.

• The management of risk associated with people’s care had improved. However, further improvement was required to ensure staff always had the information they needed to manage and reduce known risk.

• Environmental risks were well managed.

• The building was clean. Staff followed good infection control practices.

• People received their medicines as prescribed. And, overall, staff followed good medicines practice when they administered medicines.

• Staff were recruited safely, and enough staff were available to ensure the delivery of safe care in line with people’s assessed needs.

• The provider shared learning across their organisation to drive continual improvement and learn lessons when things went wrong.

• Systems to monitor the quality and safety of the service were being embedded.

• People, relatives and staff felt the management of the service had improved.

• Staff felt listened to and supported by their managers.

•People and their families had opportunities to attend meetings to share ideas and receive updates about the service.

Rating at last inspection: At the last comprehensive inspection the service was rated as ‘Requires Improvement’. The last report for Jubilee Gardens was published 18 February 2019.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This is the third consecutive time the service has been rated as Requires Improvement.

Why we inspected: At our last comprehensive inspection we found three breaches in Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection, the provider sent us an improvement action plan to inform us what they would do to meet the regulations. This was a focused inspection to check their progress and if they had now met the regulations.

Follow up: We will continue to monitor the service to ensure it meets its regulatory requirements. More information is in the 'Detailed Findings' below.

This inspection site visit took place on 11 and 12 December 2018 and was unannounced.

Jubilee Gardens is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Jubilee Gardens accommodates up to 50 people in one adapted building. The home has two floors. It provides residential and nursing care to older people who live with dementia. During the first day of our inspection visits 43 people lived at the home and one person was in hospital. On day two 42 people lived at the home. The home is located in Castle Bromwich, West Midlands.

We last inspected Jubilee Gardens in December 2017 and gave the service an overall rating of 'Requires Improvement'. The inspection identified breaches of Regulation 12 ,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not always enough staff available to keep people safe, risk associated with people’s care was not safely managed and the provider’s quality monitoring systems were not effective.

Following that inspection, the provider sent us an action plan, and which confirmed the actions required to make improvements would be completed by the end of March 2018.

At this inspection we found the provider had not fully addressed the issues we identified at the last inspection. We also found areas where the home had previously performed well had not been maintained.

This is the second consecutive time the home has been rated as Requires Improvement.

The service did not have a registered manager. A requirement of the service's registration is that they have a registered manager. 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.

The provider had appointed a new manager who was planning to apply to register with the Care Quality Commission (CQC). They had been in post for three weeks at the time of this inspection.

People did not always receive safe care because some known risks continued to be inconsistently managed and other risks we found had not been assessed. Action was taken to address this.

Staffing levels continued to affect the standard and consistency of care people received because there were not always sufficient numbers of staff available when people needed them and to keep people safe. Despite this people told us they felt living at Jubilee Gardens.

People’s medicines were not always managed and administered safely.

The management team and staff worked in partnership with other professionals to support people to maintain their health and well-being. However, recommendations made by health care professionals were not always followed and staff did not always make timely referrals to health care professionals when needed.

Improvements had been made to the accuracy and level of detail in some people’s care records. However, further improvement was required to ensure staff had the information they needed to provide safe care. Action was planned to address this. Most staff demonstrated a good understanding of the needs and preferences of the people they supported.

Staff were recruited safely and received an induction when they started work at the home. The provider supported staff through a programme of on-going training. However, staff had mixed views about the training they received. Improvements had been made to ensure staff had the opportunity to meet with the management team to discuss their role and development needs.

Management systems to check, monitor and improve the quality and safety of the service remained ineffective. Most peopl

This inspection site visit took place on 7 December 2017 and was unannounced.

Jubilee Gardens is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Jubilee Gardens accommodates 50 people in one adapted building. The home has two floors. It provides residential and nursing care to older people who live with dementia. On the day of our visit 46 people lived at the home and one person was in hospital. The home is located in Castle Bromwich in the West Midlands.

We last inspected Jubilee Gardens in November 2016 and gave the home an overall rating of 'Good'. During this inspection visit we identified a number of areas where standards had not been maintained and there were breaches of the regulations. This is the first time the home has been rated as requires improvement.

A requirement of the service's registration is that they have a registered manager. Since our last inspection the registered manager had left the home. 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. The provider had appointed a new manager who had been in post for nine weeks. The manager was applying to register with the Care Quality Commission (CQC).

The provider did not ensure there were always sufficient numbers of staff available when people needed them and to keep people safe. Staffing levels affected the standard and consistency of care people received and there were often times when there was no staff presence in some areas of the home.

The provider did not ensure risks to people’s safety and well-being were consistently identified and assessed. Where risk had been assessed some management plans were not up to date. People’s care records were not always up to date or accurate. This meant staff did not have the written information they needed to keep people and themselves safe, including in an emergency. However, staff demonstrated a good understanding of the needs and preferences of the people they supported.

Staff had not completed some of training they needed, including on-going training the provider considered essential to develop and maintain the skills and knowledge required to support people effectively and safely. The management team had not provided staff with opportunities to discuss their role and development.

Management systems to check monitor and improve the quality and safety of the service provided were not always effective. People and relatives had different views about the service provided and the way the home was managed. Improvements were being made to ensure people and relatives were included in planning and reviewing the care and support provided.

The provider had sought feedback from relatives and staff and plans were in place to use the feedback received to make improvements to the service provided.

People told us they felt safe living at Jubilee Gardens. Staff understood how to protect people from abuse and their responsibilities to raise any concerns. Overall medicines were managed and administered safely. However, some people told us they did not receive their medicine at the times they expected.

Staff were recruited safely and completed an induction in line with best practice when they started working at the home. People received their care and support from staff who they knew. People were not routinely provided with opportunities to take part in activities they enjoyed which were meaningful.

The management team and staff understood the principles of the Mental Capacity Act (MCA) and their responsibilities under the Act. However, some

This inspection took place on 10 November 2016 and was unannounced.

Jubilee Gardens provides residential and nursing care for up to 60 older people, many of whom lived with dementia. The service is a two storey, purpose built building that is split into four wings. At the time of our inspection visit 57 people used the service.

The registered manager had resigned from their position two days prior to our inspection. This registered manager had been in role for approximately four months and was employed to replace a previous registered manager who left the service in August 2016 after an extended period of illness when they were absent from their role. 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 .

Jubilee Gardens was last inspected on 30 July 2014 and was rated as “Good.” The provider displayed this rating in the entrance of the home and on their website as required by their registration requirements.

Prior to our inspection we received a written report from a coroner which included a recommendation for Jubilee Gardens. This related to improvements needed in the quality of information provided about a person’s care and support needs on transfer to a new care provider. During our inspection we saw that the provider had taken action following this report and had introduced more in-depth transfer paperwork which clearly identified any risks to an individual.

People and relatives told us Jubilee Gardens was a safe place to live and people were well cared for. People were supported by staff who knew how to keep people safe and were aware of how to report any safeguarding concerns. Risks to people’s health and wellbeing were assessed and staff were informed of how to minimise any identified risks. People received their medicines as prescribed from staff who had received training to do this safely and who had regular checks of their competencies.

The provider had recently increased the number of care workers on each shift. This meant that there was enough staff to support people who lived in the home and they were available at the times people needed them. When staff were recruited to work at the home checks were carried out to ensure their suitability to work with people who lived there. Staff received training so they had the skills and knowledge to meet the specific needs of people who lived at the home. Staff supported people to maintain their health and made referrals to healthcare professionals when needed.

People were supported in line with the principles of the Mental Capacity Act. The manager understood the importance of applying for Deprivation of Liberty Safeguards (DoLS) when necessary. Staff ensured they maintained people’s privacy and dignity, and treated people with compassion and respect.

People’s preferences were considered in all aspects of care they received. People were offered a choice of meals based on their preferences and dietary requirements. The provider had arranged for additional training and resources to be provided to support people who lived with dementia to pursue their individual hobbies and interests. People were supported to maintain relationships with people who were important to them.

People and relatives thought that communication regarding changes in management could be improved. Staff felt supported by the provider’s senior management team however felt that the home’s management was inconsistent due to changes in the past six months. People and their relatives knew how to raise complaints however relatives told us that when they had raised concerns in the past they had not always received a response from the registered manager.

The provider monitored the quality and safety of the service provi

We carried out this inspection on 30 July 2014 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by Care Quality Commission (CQC) which looks at the overall quality of the service. This inspection was unannounced.

Jubilee Gardens provides residential and nursing care to older people with dementia. It is a purpose built home which provides care for 50 people. The home has four separate units. One supports people who need residential care and the other three support people who need nursing care.

Jubilee Gardens is required to have a registered manager in place. At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

On the day of our inspection there were 46 people living at Jubilee Gardens and of those, 34 people required nursing care.

The service did not always engage people in individual interests. Opportunities were missed in supporting people living with dementia to undertake daily life tasks and retain those skills.

People who lived at Jubilee Gardens and the staff who supported them thought people who lived at the home were safe. There were systems and processes in place to protect people from the risk of harm. These included robust recruitment practice, staff training, environmental, equipment, and building audits.

People told us staff were kind and respectful to them. We observed staff being caring to people throughout the time we inspected the home. We saw staff respected people’s dignity and privacy when providing care.

We assessed the information provided about the needs of people living at the home and the number of staff available to meet people’s needs. We found there were sufficient staff to meet people’s needs.

The service employed two staff to provide social and emotional stimulation for people. We saw people enjoyed the group events, however we saw less engagement with people on an individual basis unless it was as part of a care task.

Staff understood they needed to respect people’s decisions if they had the capacity to make those decisions. Assessments had been made and reviewed about people’s capacity. Where people did not have capacity, decisions were taken in their ‘best interest’. This meant the service was adhering to the Mental Capacity Act 2005.

The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Where people had been assessed as needing their liberty restricted to keep them safe, referrals had been made to the local authority for their approval.

People’s health and social care needs were appropriately assessed. Care plans provided accurate and up to date information for staff to help them care for people effectively. Any risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to help keep people safe.

There were effective management systems in place to monitor and improve the quality of service provided. Staff told us they felt able to talk with the manager if they had any concerns or opinions and they would be listened to.

We last visited Jubilee Gardens in September 2013. We saw the service had not met its regulatory responsibilities to provide safe and effective care to people. We visited Jubilee Gardens on 6 March 2014 to follow up on actions the provider told us they were going to take to improve the care delivered to people living in the home.

We looked at how people were being cared for at each stage of their care and treatment. We talked with people who used the service, relatives and staff.

Three inspectors visited Jubilee Gardens. The service has four units, Balmoral, Kensington, Clarence and Windsor. At our last visit our concerns were mostly in relation to the care provided in the nursing units. During this visit we focused our inspection on the nursing units of Balmoral, Kensington and Clarence.

We observed staff interacting with people with kindness. They demonstrated through one to one discussions with us that they knew the care needs of the people they looked after.

One family member told us, “Staff have been superb, they look after X like we would, we couldn’t ask for better care,”

We reviewed the care of seven people with varying levels of need. We found the service had made significant improvements with people’s care and treatment.

We saw there was a sufficient supply of equipment to meet people’s needs.

We saw staffing levels and training had improved. Staff were responding to people’s needs in a timely way.

Three inspectors visited Jubilee Gardens. This was to enable us to cover more areas of the home. We were following up on concerns raised during our last visit on 8 July 2013.

We observed staff interacting with people with kindness. One family member told us, “They are now managing X’s diabetes well…all the staff are kind and will do anything you ask of them.”

We reviewed the care of seven people with varying levels of need. Some were unable to communicate with us so we spent a period of time observing how people were being cared for within the home.

We found the service had made some improvements with people’s care and treatment and nutritional support.

We saw risks associated with people's care were not always effectively managed. This included those people whose behaviour may be seen as challenging, people at high risk of falls and people with diabetes.

Staffing levels did not always meet people’s needs. The manager was recruiting more staff. They told us it had taken longer to recruit nursing staff than originally expected.

We observed that the home did not have an adequate supply of equipment such as recliner chairs, slide sheets and pressure relieving cushions to meet the needs of individuals.

Quality monitoring systems had improved. We saw the service had identified risks and put actions plans in place to improve the experiences of people who lived at the home. Not all of these actions had been completed at the time of our visit.

Jubilee Gardens was visited by two inspectors and an expert by experience (ex by ex). The ex by ex spoke with four people who lived in the home and two visitors. They told us: “Lovely”. “I’m very happy.” “Nice living here.” “I am happy with the service.” “X is well settled and looked after.”

We reviewed the care of six people. We found there were people of varying levels of need. Some people were unable to communicate with us so we spent a period of time observing how people were being cared for across the four units within the home.

We found there were improvements needed across all standards we inspected. We saw that risks associated with people’s care were not always effectively managed. This included those people at risk of pressure sores to their skin and poor nutrition.

Quality monitoring systems were in place but were not fully effective in ensuring people received the care and services they should expect.

We observed staff to be friendly and approachable and people were positive about the staff. They told the ex by ex "Very nice.” “Staff are nice.” “Everybody’s so nice.” Visitors stated: “They’re very good, in the last few weeks there have been sufficient staff and they’re always around.” “Staff are always obliging and willing to address concerns…”

The safe handling of medicines was assessed by a pharmacist inspector. The reason for this inspection was to follow up on a compliance action made following an inspection in October 2012 relating to medicine management. We received an action plan from the provider which told us that all actions had been met and updated by 14 January 2013. We spoke with three members of staff, looked at the storage of medicines and medicine records. At this inspection visit we found improvements had been made in medicine management.

We spent time talking with four people and four visitors about their experiences of Jubilee Gardens. We also carried out a period of observation over lunchtime in two of the dining rooms.

We saw that people were being supported appropriately. We found that staff had a good knowledge of people’s needs. Staff spoke with people in a friendly, respectful way. We saw records confirming most staff had completed the required training to support people safely.

We asked people if they were being looked after alright. They told us: “Yes”. “Not too bad.” Visitors told us: “The care assistants have been brilliant with X.” “They are absolutely marvellous…..” Visitors also told us they were kept informed about any concerns relating to their relative.

We looked at people’s medication and found that some improvements were needed to ensure people received their medicines as prescribed.

We saw that a range of meals were being provided with choices being offered to people each day. People and visitors we asked about the food told us: “Very good.” “Not as good as I would like, it’s alright.” “She is always saying it is good….”

We saw that some social activities did take place but they were limited. We asked people and visitors about these. They told us: “There is not so much going on here, they do exercises and things like that.” “I don’t know because I don’t come during the day. According to mum nothing.”

People were satisfied with the care they received at Jubilee Gardens. They appreciated the efforts made by care workers. One person told us "It's lovely; everybody is very lovely". Another said "We moan, but they are alright". She went on to describe a particular carer: "she is so kind".

A person visiting her relative said: "You could find imperfections, but they try their best. It is not always easy. There are some very caring staff here. I'm satisfied". Another relative told us that his relative received "very good care".