Stella & Harry Freedman House

About the service

Stella & Harry Freedman House (previously known as Lady Sarah Cohen House ) is registered to provide accommodation for up to 120 people who require nursing or personal care and treatment of disease, disorder or injury.The service supports people from the Jewish community. On the day we inspected there were 105 people living in the home .

People’s experience of using this service and what we found

People had access to healthcare services and were involved in decisions about their care. Partnerships with other agencies and health professionals enabled effective outcomes for people. Staff supported people to take medicines safely.

People's care was planned and risks to their safety and wellbeing were assessed. The service reviewed these plans regularly, involving people in these reviews and asking for their opinions. However, some risk assessments for people with mental health conditions lacked sufficient detail at the time of our inspection.

Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice. Recruitment practices were safe and relevant checks had been completed before staff worked at the service.

People and staff praised the managers of the service and agreed that they were approachable, knowledgeable, fair and did their job well. The staff team worked well together and supported the interim manager.

The staff team was committed to providing a high-quality service. They had undertaken training so that they were skilled and knowledgeable to effectively meet people’s needs.

Staff encouraged people to be as independent as possible and respected people’s privacy and dignity.

Staff consistently strived to ensure that people had the best possible care, and that they were supported in a compassionate, dignified and safe way.

People were given choices about the way in which they were cared for. Staff listened to them and knew their needs well.

Care plans contained information about each person’s individual support needs and preferences in relation to their care and we found evidence of good outcomes for people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The managers of the service actively sought the views of people and their relatives about the running of the service and they dealt promptly with any concerns that people raised.

The provider had systems in place to monitor and improve the quality and safety of the service provided. There was a positive culture throughout the service. Staff told us they enjoyed working at the service and felt valued.

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

Rating at last inspection

At the last inspection we rated this service Good. The report was published on 21 June 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the Key Questions Safe, Effective and Well Led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• The provider had developed new ways of recording observations about people’s health which were shared with healthcare professionals in advance of appointments. This had reduced the need for external visitors to the home, and had facilitated smooth virtual consultations with healthcare professionals.

• The provider was following best practice guidance in terms of ensuring visitors to the home did not introduce and spread Covid-19. They had a visitors’ code and visitors’ policy that family members and other visitors had to sign and adhere to. A system of allocated appointments was developed for family visiting in residents rooms and in the visiting pod which would ensure visitors to the home were minimised.

• Information and instructions for visitors were clearly displayed and explained by the receptionist upon arrival. Our observations during the inspection confirmed staff were adhering to Personal Protective Equipment (PPE) and social distancing guidance. Infection prevention posters were clearly displayed within each unit of the home.

• The provider had a detailed admission process which included a Covid-19 assessment. The provider liaised with the local hospital for all admissions and requested that a Covid-19 swab test be carried out before discharge from hospital. New residents were required to test and then isolate when first arriving at the home. The provider communicated with family members throughout this period.

• The provider had set up donning and doffing PPE stations across the care home.

• Staff had been appropriately trained in the use of PPE and infection control processes.

• A comprehensive Infection Prevention and Control audit was carried out at the start of the pandemic. This was kept in review by infection control visits carried out by senior members of staff.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There were 94 people living at the service on the day of the inspection, the majority of whom were over 65 years of age with disabilities.

We last inspected the home on 4 and 9 January 2017 when we found the provider was in breach of three regulations, in relation to staffing levels, governance of the service and the safe management of medicines. At this inspection we found improvements had been made and the service was no longer in breach of any regulations.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the 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.

People using the service told us they felt safe at the service. There were systems and procedures to safeguard people from abuse and staff had a good understanding of their role in protecting people from harm and abuse.

We saw staff were kind and caring and people told us this was the case.

Medicines were safely managed at the service; stocks tallied with records and were stored appropriately.

Recruitment checks and other related documentation required were in place prior to staff starting work, so staff were considered safe to work with vulnerable adults.

We found there were enough staff to meet peoples’ needs.

Care records were detailed and together with risk assessments provided guidance to staff in managing people’s needs.

There was a choice of menu and food was of a good quality, prepared in line with Kosher dietary laws.

There were quality audits in place which covered key areas including medicines, care plans, staff supervision and the service offered at night. There were effective management systems in place to ensure training took place, and there was compliance with health and safety issues.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We have made two recommendations in this report. We have made a recommendation about the provider obtaining the views of people regarding their personal experience of care, and that they review their medicines policy and practice.

Lady Sarah Cohen House is a nursing home registered to provide accommodation, nursing and personal care and support for up to 120 older people. Lady Sarah Cohen House is operated and run by Jewish Care, a voluntary organisation. At the time of our inspection, 104 people were living in the home.

The home is purpose built with dining and lounge areas on each floor. The home has 120 bedrooms with ensuite facilities split across three floors. All the floors are accessible via lifts and there is an accessible garden. The home shares kitchen and laundry facilities with another care home from the same provider. The home is part of the Betty and Asher Loftus centre, a community hub with access to a synagogue, shop and a café.

There was a manager in post, they were undergoing registration process with the Care Quality Commission. A registered manager is a person who has registered with the 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.

People using the service told us they felt safe at the service. Staff had a good understanding of the safeguarding procedure and their role in protecting people from harm and abuse. The service had systems to identify and manage risks. The service maintained detailed risk assessments which were regularly reviewed, but we found a number of gaps. There was an improvement in daily care records since our last inspection however we found inconsistencies in them. People were generally happy with the support they received from staff administering their medicines. We found errors in medicines administration records (MAR) charts. The service was clean and had effective measures in place to prevent cross contamination.

The manager and service manager told us that there were sufficient numbers of staff employed to ensure that people's individual needs were met. However people, their relatives and staff told us there were not enough staff available at all times to meet people's individual needs.

People were provided with choice of food at meal times. Not all staff used appropriate methods to support people in making choices of what they wanted to eat. The service worked closely with various health and care professionals to support people with their needs and wishes.

The service followed safe recruitment practices. Staff received induction and regular training, and records confirmed this. Staff told us they found supervision useful and received regular one-to-one and group supervisions. The service was reviewing their appraisal system.

The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People told us staff asked their consent before supporting them. The manager and staff demonstrated a good understanding of the procedures under MCA and DoLS.

People using the service and their relatives told us they found staff friendly and caring. People told us staff listened to them and their individual health and care needs were met. However, they said agency staff were not always helpful and did not know people’s needs.

The care plans included people’s life histories, individual needs and likes and dislikes. People and their relatives were involved in planning their care. The service offered people a range of activities. People and their relatives told us they were asked for their feedback and their complaints were acted upon.

There was evidence of regular monitoring checks of various aspects of the service. However, these systems were not effective in ensuring records relating to people who used the service were accurate and up to date.

We have made a recommendation about accessing specialist advice in creating dementia friendly environment and specialist dementia training for staff.

We found that the registered provider was not meeting legal requirements and there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to sufficient numbers of staffing to meet people's care and treatment needs, effective systems for the safe administration of medicines, recordkeeping and audits of care delivery.

Care plans we looked at were wide-ranging and assessed people's individual needs and risks. They were regularly reviewed and mainly up to date. People's religious and cultural needs were recorded and respected and relatives told us that staff 'know each individual person and treat them as individuals.'

The home provided induction and a variety of other training for staff, who also received regular supervision. The manager was in the process, prior to the inspection, of addressing consistency of supervision and recording and ensuring that training impacted on practice.

Records relevant to people's care and the management of the services were generally accurate and fit for purpose. Records were kept securely and could be located promptly when needed.