CQC report explained · a nursing home
What the CQC found at Jubilee Court
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, April 2023
Jubilee Court is rated Good; inspectors found safe, personalised care and clear improvements since the previous inspection.
This was an unannounced focused inspection on 6 and 9 March 2023. Inspectors looked at safe, responsive and well-led care. They spoke with people, relatives, staff and a professional, and reviewed care, medicine, staffing and management records.
Inspectors found enough suitably trained staff, safe medicine arrangements and good systems for managing risks, safeguarding and infection control. People said they felt safe and were supported by kind staff who knew them well.
Care was tailored to people's needs and preferences. People were supported with activities, relationships, communication and end of life wishes. Complaints were recorded and investigated.
The home was rated Good overall and Good for Safe, Responsive and Well-led. Its previous rating was Requires Improvement, with two breaches. Inspectors found improvements had been made and said the home was no longer in breach of those regulations.
Improved staffing
Inspectors found enough suitably trained staff, and records showed staffing levels were based on people's assessed needs. People and relatives said staffing had improved since the previous inspection.
“People, their relatives and staff told us staffing levels had improved significantly since our last inspection.” from the report
Personalised support
Care plans gave staff clear guidance about people's needs, preferences and communication. Inspectors saw staff support someone kindly and effectively at mealtime.
“People received personalised care and support tailored to their needs and preferences.” from the report
Activities and relationships
People helped shape the activities provided and were supported to maintain important relationships. Relatives were invited to events at the home.
“People were fully supported to choose and engage in activities to ensure they lived fulfilled lives.” from the report
Stronger management systems
The home had introduced audits, daily checks and an improvement plan. Inspectors found these systems had become embedded since the previous inspection.
“Quality assurances systems and processes had been fully embedded, and improvements made since our last inspection.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you check staffing levels when a resident's physical or mental health needs change?
- 02How often will my relative's care plan be reviewed, and how will the family be involved?
- 03How are complaints investigated, and how will I be told what action has been taken?
- 04What quality checks are carried out now, and how do you track actions in the home improvement plan?
- 05How will you support my relative to choose activities and maintain important relationships?
This was an unannounced focused inspection of Safe, Responsive and Well-led only; the report says ratings for the other key questions were carried over from the previous inspection. This explanation was written from the published report of 18 April 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2022
Rated Requires Improvement; inspectors found risks from staffing shortages and weak management oversight, although medicines and infection control were handled safely.
This was an unannounced focused inspection on 12 and 13 January 2022. One inspector visited the home, spoke with staff, reviewed records and rotas, and gathered feedback from relatives and health professionals.
Inspectors found there were not always enough staff to supervise people safely. This was linked to unwitnessed falls and care not always being completed as often or to the standard expected. Care plans were not always personal enough, although staff who knew people understood their needs well.
The home was rated Requires Improvement overall. Safe, responsive and well-led were all rated Requires Improvement. Effective and caring were not inspected, so their previous ratings were used when calculating the overall rating. The previous overall rating was Good, published in November 2019.
Medicines
Inspectors found medicines were given as prescribed, recorded properly and administered by trained staff whose competence had been checked.
“Medicines were managed safely. People received their medicines as instructed by the prescriber.” from the report
Infection control
The home had arrangements for testing, protective equipment, visiting and managing infection risks during the COVID-19 pandemic.
“We were assured that the provider was preventing visitors from catching and spreading infections.” from the report
Staff knowledge
Although some care plans lacked personal detail, staff who knew people understood their individual needs, likes and dislikes.
“However, staff had a good understanding and knowledge of people's individual care and support needs, including their individual likes, dislikes and preferences.” from the report
Complaints
The home had a complaints process, and inspectors found recent complaints had been investigated and answered in line with its procedures.
“Records showed concerns and complaints had been investigated and responded to in line with the provider's policies and procedures.” from the report
Staffing shortages
seriousThere were vacancies and staff absences were not always covered. Inspectors said this meant people were not always supervised safely or given the support they needed.
“There were not always enough staff to ensure appropriate levels of supervision and observations to keep people safe.” from the report
Falls risk
seriousLow staffing levels meant staff could not always follow people's falls risk assessments. Falls analysis also did not always explain the effect of low staffing or prevent repeat falls.
“The low number of staff on each unit and the unique layout of the building meant staff were not always able to follow people's risk assessments.” from the report
Personal care
needs fixingRelatives reported that washing, hair care and suitable clothing were not always provided as often or to the expected standard. Some care plans were focused on tasks rather than the person.
“People's had not always received their care in personalised way to meet their needs.” from the report
Incomplete records
needs fixingFluid and repositioning charts were not always complete. Gaps were not investigated, so managers could not be sure planned care had been given.
“We looked at range of supplementary charts such as fluid intake or repositioning and found these were not always fully complete.” from the report
Management oversight
seriousThe provider's checks did not reliably identify staffing, record-keeping and falls risks. Inspectors found this put people at risk of not receiving planned care.
“The provider failed to operate effective systems and processes to assess, monitor and improve the quality and safety of the service.” from the report
- 01How many staff are now on each shift, and how do you cover vacancies and sickness?
- 02How do you identify people at high risk of falls and make sure their risk assessments are followed?
- 03What changes have been made to care plans so they describe each person's preferences and personal care needs?
- 04How are fluid and repositioning records checked, and what happens when there are gaps?
- 05What action has been completed in response to the improvement notice and the CQC action plan?
This was a focused inspection of Safe, Responsive and Well-led, including infection control; Effective and Caring were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 16 February 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Jubilee Court
5 rated inspections over 8 years: the service has held its Good rating throughout.
- April 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2022Requires improvementdown from GoodSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2019Goodstayed GoodSafe: GoodResponsive: OutstandingWell-led: Good
- February 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- March 2012
Registered with the Care Quality Commission on 29 March 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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