Jasmine Court Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The provider had systems and processes in place to keep people safe from abuse. However, staff used unsafe practices to support people with their moving and handling needs. Risks to people were not safely monitored and managed to support them to stay safe. Risk assessments lacked detail to provide staff with sufficient guidance as to how the risks posed should be mitigated. De-escalation techniques were not routinely used or considered prior to the use of restraint by staff. Minor improvements were required to the service’s recruitment practices and to some aspects of medicines management. There were enough staff deployed but people’s and relatives’ comments relating to staffing were variable. Although staff had received appropriate training, staff's practice did not always provide assurance they were skilled and competent to effectively apply their learning in their everyday practice.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us an assessment was carried out by the service prior to their family member being admitted to Jasmine Court Nursing Home. They told us they were given an opportunity to visit the service.

The registered manager told us about the provider's assessment and admission process. They confirmed that people’s care and support was planned where possible with the person, those acting on their behalf and other key partners to ensure continuity of care.

People’s needs were assessed prior to their admission to the service and this information was used to inform their care plan and risk assessments. People’s protected characteristics under the Equalities Act 2010, such as age, disability, religion, and ethnicity were identified as part of their need’s assessment.

People and their relatives told us they felt safe. People’s comments included, “I feel reasonably safe” and, “I feel safe. It’s having the security of people always being around.” Relative’s comments included, “Yes, family member is safe here. I just feel confident in the staff” and, “I feel family member’s safe because I’ve seen the way staff manage them. There’s always 2 of them [staff], when they are being hoisted.”

Staff had received training on how to recognise and report abuse. Staff were able to tell us about the different types of abuse and what to do to make sure people were protected from harm. They were confident any concerns would be taken seriously and acted on by the management team.

During the assessment we observed staff using unsafe practices to support people with their moving and handling needs.

The registered manager was aware of their responsibility to notify us and the Local Authority of any allegations or incidents of abuse at the earliest opportunity.

People and their relatives told us how most staff knew the people they supported well and were able to identify risks to them and or their loved ones and how staff supported them on a daily basis. While people spoken with expressed, they were generally happy with their care, our assessment found elements of care practice did not meet the expected standards.

Staff spoken with demonstrated an understanding of the individual risks posed to people being supported. Specifically, staff were able to tell us how they supported people who could become anxious and distressed, the preventative measures to be taken for people who were at risk of developing pressure ulcers and people who were at risk of falls or who experienced difficulty mobilising. While staff’s comments were positive, our assessment found elements of poor care practice that placed people at potential risk of harm. Staff were able to describe how they ensured referrals were made to external organisations as needed. A member of staff provided an example whereby a recent referral had been made to a dietician to ensure the person’s dietary needs were met.

Risks to people were not safely monitored and managed to support them to stay safe. We observed 3 separate incidents whereby staff performed unsafe moving and handling practices. This referred to staff putting people at potential risk of harm by placing their hands under people's underarms when assisting them with transfers, by pulling them up from a comfortable chair by their wrists, and by pulling a person who was at high risk of falls, backwards by their arms whilst they walked. One of the incidents involved a senior member of staff. The same senior member of staff also witnessed junior members of staff executing poor practice but failed to intervene and provide appropriate instruction and support. Following our assessment the provider forwarded an action plan to us. This confirmed immediate action was taken by the provider to address our concerns. Observations of staffs practice was completed with staff being retrained and an internal investigation undertaken.

Most risks to people's health and wellbeing had been assessed, which identified the risks they could be exposed to, and the support needed to minimise the risks. However, these lacked detail to provide staff with sufficient guidance as to how the risks posed should be mitigated. This meant we could not be assured staff had all information required to manage the person's risks in a safe and effective way. Where people exhibited behaviours that could be distressing to themselves and others, records failed to demonstrate restraint must only be used by staff when absolutely necessary and only in exceptional circumstances. Records showed de-escalation techniques were not routinely used or considered prior to the use of restraint by staff. Observation data failed to provide necessary information detailing staffs’ interventions and outcomes when a person became anxious and distressed. It was evident some records were inappropriately recorded as they did not always reflect incidents where the person was in fact anxious and distressed. Where people required their body to be repositioned at regular intervals because they were at risk of developing pressure ulcers or had an existing pressure ulcer, records demonstrated this was not happening as stated. Additionally, where people required their dressing to be changed, we found this had not always been completed as stated within their care plan.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s and relatives’ comments relating to staffing were variable. A person using the service told us, “Sometimes, there is not always enough staff.” The person implied this was predominately at weekends and meant if they used their call alarm to summon staff assistance, they often had to wait for staff to arrive. A second person told us, “They’re [staff] always short.” A relative stated, “I don’t feel there’s enough staff for X needs.” They told us when their family member’s 1 to 1 hours were reduced, there would be sufficient staff available to help their family member to dress and to assist them to eat at mealtimes. However, on some occasions they had found their family member was either not or incorrectly dressed in inappropriate items of clothing. Another relative told us, “Sometimes I don’t think there’s enough staff and staff are rotated.” The impact of this meant there were not sufficient staff available that knew their family member’s specific food and drink preferences. Messages were not always communicated and passed on, resulting in their family member having large quantities of food piled on their plate which they found off-putting and given food items they disliked. Positive comments from a person using the service included, “They [staff] seem to manage, everything on time. I get my food and drinks regularly and if I press the bell in the night, they always come.”

Staff’s comments about staffing levels at the service were variable. Where comments were negative, these referred to staff voicing a need for additional staff due to the number of people identified as requiring a high level of support due to living with dementia and experiencing anxious and distressed behaviours. Not all staff felt able to sit and talk with the people they supported for any meaningful length of time. Most staff felt the use of agency staff at the service was a positive experience. However, some staff experienced not all agency staff were effective and could be relied upon. Positive comments from staff included, “I think there are enough staff” and, “Staffing levels are fine. If we don’t have enough staff due to staff sickness, we try to get additional staff and if not possible, agency staff are used.” Where people required 1 to 1 support from staff, it was confirmed that people always received this for their commissioned hours. Staff told us they received both online and face-to-face training opportunities. Staff confirmed they felt supported and received regular formal supervision.

On the day of our assessment there were enough staff deployed in line with staffing levels stated by the registered manager. Observations throughout the day demonstrated call alarms to summon staff assistance were responded to in a timely manner. However, throughout the assessment, staff employed to provide 1 to 1 support to individual people, demonstrated very little engagement and communication with those being supported. Staff were either stood or sat outside people’s bedroom or walked alongside them silently with little interaction. Observation of staff's practice did not provide assurance staff were skilled and competent to effectively apply their learning in their everyday practice. For example, although staff had received 'practical' moving and handling training, not all staff's practice was effective or safe. Some members of staff lacked the skill and ability to effectively communicate with the people they supported, particularly where people were living with dementia and found it difficult to verbally communicate.

The provider had not always ensured staff were safely recruited. We saw gaps in recruitment files. For example, there was no proof of identification, confirmation of their right to work in the United Kingdom and no health declaration for 1 member of staff. There was no second reference for another member of staff. A written record was not completed or retained for 2 members of staff to demonstrate the discussion taken place as part of the interview process and the rationale for staff's appointment. Although interview questions were available for another member of staff, there was no evidence to demonstrate these included questions relating to their intended role. There was no evidence to demonstrate 2 out of 3 members of staff had received a formal induction. Staff were subject to Disclosure and Baring Service [DBS] checks. These checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Following our assessment, the provider wrote to us and confirmed not all information to demonstrate compliance with the above had been made available to the inspection team. Therefore, additional records were submitted for us to review, and these provided an assurance that the provider's recruitment practices were satisfactory. Profiles were evident for agency staff deployed to the service. However, there was nothing recorded to signify the external agency had completed all necessary and required employment checks on their staff. Out of 6 profiles explored, there was no induction evident for 3 agency members of staff. This was not in line with the provider’s recruitment policy and procedure. Staff received training appropriate and relevant to their role.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives, we spoke with told us they had no concerns regarding the management of their medicines. Comments included, “X refuses sometimes but staff come back later and try and again. X does get pain in their knees and legs; I know staff give them analgesia regularly.”

Staff were able to competently describe how they supported people with their medicines management. Staff confirmed they had received appropriate medicines training and had their competency assessed at regular intervals to ensure their practice remained safe. A member of staff told us the registered manager had observed their practice, ensuring they were capable and knowledgeable when administering medicines.

People’s diabetes medicines were not always managed in line with their care plan and instructions provided by specialist healthcare professionals. PRN ‘as required’ protocols were not routinely person centred. For example, where a person was unable to request their ‘as required’ medicine, the PRN protocol failed to provide staff with guidance on the signs shown by the person when this was required. During our assessment staff were observed to administer people’s medicines appropriately and in line with current guidance. The medication rounds were evenly spaced out throughout the day to ensure people did not receive their medicines too close together or too late. Observation of staff practice showed staff undertook this task with dignity and respect for the people being supported.