Archived: Rubens House

At the last inspection we found that people using the service were insufficiently protected by the service's procedures to ensure that all decisions were made in their best interests within the requirements of the Mental Capacity Act 2005. The care and treatment delivered did not always meet people’s needs and reflect their preferences. Risks to people’s health and safety had not been appropriately assessed and the service was not doing all that is reasonably practicable to mitigate any such risks which included the proper and safe management of medicines. The nutritional and hydration needs of people were not always met. Sufficient numbers of staff were not always deployed to meet people's needs effectively. The service failed to effectively operate systems to: assess, monitor and improve the quality and safety of the services provided.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least good. During this inspection we found that the service had made appropriate improvements to the issues that we identified and how they planned to ensure sustainability of these improvements for the future.

Rubens House is a ‘care home’. 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.

Rubens House accommodates up to 46 people in one purpose built building. Rubens House is operated and run by Jewish Care, a voluntary organisation and supports people from the Jewish community. Within the building there are three floors, each of which has separate adapted facilities. All three floors specialise in providing care and support to people living with dementia and physical health needs. At the time of this inspection there were 32 people using the service.

At the last inspection the provider had transferred an experienced manager from one of their other locations. This manager had become the registered manager for Rubens House. 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.

People and relatives told us that they were safe living at Rubens House and that care staff ensured their safety at all times. Care staff demonstrated a good understanding of how to keep people safe and how to protect them from risk of abuse or harm.

Each person’s individual risks associated with their health and care needs had been identified and clear guidance was available for staff on how to reduce and mitigate the known risks to ensure people’s safety.

The service had policies and procedures in place to ensure the safe management and administration of medicines. Issues noted at the last inspection had been addressed.

Robust recruitment processes were in place to ensure only staff assessed as safe to work with vulnerable people were recruited. We observed there to be sufficient staff available to support people with their needs. Staff did not seem to be rushed and people’s needs were met appropriately. The service manager used a level of need assessment tool to ensure that appropriate staffing levels were maintained to ensure people’s needs were safely met.

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.

Care plans contained appropriate documentation confirming consent to care had been obtained and where people lacked capacity, best interest decisions had been made and documented in partnership with the relevant involved individuals. Care staff were clearly able to explain their understanding of the MCA and DoLS and how this impacted on the care and support that they delivered.

People and relatives told us that they enjoyed the food at Rubens House. We saw plenty of drinks and snacks around the home that were available to people as and when they so desired. Where people were noted to have specific risks associated with their nutrition and hydration these had been clearly documented and appropriate measures had been implemented to monitor this.

Since the last inspection significant refurbishment work had been carried out to improve the environment of the home in order to make it more accessible and dementia friendly.

Records seen confirmed that staff received regular supervisions and annual appraisals as well as regular training to enable them to deliver safe and effective care.

We observed positive and caring relationships that people had developed with other people living at the home and with the entire staff team at the home. Issues noted with the use of agency staff had been addressed with the use of regular, known agency staff that regularly worked at the home.

Care plans were person centred and detailed. The provider was in the process of transferring all care plans on to an electronic care plan but this piece of work was being completed on a phased basis so as to minimise disruption. Detailed work had been completed around people’s life histories called ‘Remarkable Lives.’

As part of the electronic care planning system the service had already begun to record all daily living activities and monitoring onto the care plan. This included daily recording, food and fluid monitoring and activities participation. The electronic care plan was a live document that ensured entries of relevance were made at any time with reminders where a time lapse in recording had been noted.

Improved systems were in place to monitor and check the quality of care provided. We received consistently positive feedback from people, relatives and staff regarding the management structure in place, the support they received and the improvements that had been made.

The senior management team were always accessible to people, relatives and staff who spoke positively about them and felt confident about raising concerns.

Rubens House is a home registered to provide accommodation and personal care and support for up to 46 older people. Rubens House is operated and run by Jewish Care, a voluntary organisation. At the time of our inspection 43 people were living in the home. The home is purpose built with dining and lounge areas on the ground floor. The home has 48 bedrooms all with hand basins and some with ensuite facilities split across four floors. All the floors are accessible via lifts and there is an accessible garden. The home has a kitchen and a synagogue, and laundry and hairdresser facilities.

The provider had moved one of their experienced and long standing registered managers to this home since the departure of the previous registered manager. The new manager had only been in post for two weeks during the time of inspection. They were in the process of becoming registered manager for this service. 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.

The service had systems to identify and manage risks but they were not adhered to. People’s risk assessments were not regularly reviewed and we found a number of gaps in them. People’s health and care records were incomplete and inconsistent. Although, people were happy with the medicines support, the service lacked systems for safe medicines administration. We found gaps in medicines administration records and staff did not always follow safe medicines administration practice.

Although, the management felt there were sufficient numbers of staff deployed to meet people's individual needs. People, their relatives and staff told us there were not enough staff available at all times to meet people's individual needs. People’s nutrition and hydration needs were not always met.

The service did not operate within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Although, people told us staff asked their consent before supporting them. People who lacked capacity to make decisions were not appropriately supported.

People’s care plans were incomplete and not regularly reviewed. People were not always supported as per their care plans. Although, the service offered people a range of group activities, there was lack of activities for people with complex needs. People and their relatives told us they were comfortable in raising concerns and their complaints were acted upon.

There was lack of evidence of regular monitoring checks of various aspects of the service. The audit processes were not effective in ensuring records relating to people who used the service were accurate and up to date.

People using the service and their relatives told us they found staff friendly and caring. People told us staff listened to them. However, they said agency staff were not always helpful and caring.

Most 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 was clean and had effective measures in place to prevent cross contamination.

Most people were happy with the food and told us they were given plenty of choice at meal times. The service worked with various health and care professionals to support people with their needs and wishes.

The service followed appropriate recruitment practices. Staff including agency staff received induction and regular training, and records confirmed this. Staff were provided with regular one-to-one and group supervisions. The service was reviewing their appraisal system.

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 person centred care, need for consent, sufficient numbers of staffing to meet people's care and treatment needs, effective systems for the safe administration of medicines, nutrition and hydration and recordkeeping and audits of care delivery.

You can see what action we asked the provider to take at the end of this report.

At the time of this inspection the home had 44 people who used the service. Three of them were in hospital at the time of inspection. Some people who used the service have dementia.

We observed the care provided and the interaction between staff and people who used the service. We spoke with five people who used the service, two relatives and a healthcare professional. We also spoke with the service manager, the home manager, Care Manager, activities organiser, and care staff individually.

Five people who used the service and two relatives told us that they were satisfied with the care. One person stated, 'I am satisfied with the care provided. Staff are aware of our cultural needs. They are very kind.' Another person said, 'I am happy with the care. There are enough activities. The staff are responsive if I need help they come to me.'

People's care needs had been assessed before they arrived at the home and care plans were in place to ensure that their needs were met. People and their representatives had been consulted regarding their preferences and activities they liked to engage in. The service had a varied programme of social and therapeutic activities and we saw that people could participate in activities if they chose to. We were informed by the healthcare professional that the home had ensured that the healthcare needs of people were attended to.

People who used the service informed us that their bedrooms were comfortable and had been kept clean. One person said, 'My bedroom is very clean and I can display my pictures and ornaments.' Another person said, 'I am happy with my bedroom.' A relative stated, 'The premises are usually clean although occasionally the toilets are sometimes smelly.' Bedrooms inspected were clean, adequately equipped and had been personalised by people who used the service. There was a record of essential maintenance carried out and Health and Safety checks were documented. However, the registered provider may wish to note that some communal areas and doors showed signs of wear and tear and paintwork in some areas was cracked. There was also a need to further review the safety risks posed by the fire door next to the office on the ground floor.

People who used the service, relatives and staff informed us that on the whole there were sufficient staff to attend to their needs. One relative expressed concern regarding night staffing arrangements and a staff member informed us that occasionally an additional care staff was needed. The team leader during the night shift who is responsible for overseeing the care needs of people on one floor was also responsible for administering medication for people in the whole home. This may place people at risk since it would be difficult to adequately supervise people while they were administering medication.

The home had a system for ensuring that the services provided were of a high quality. This included regular audits and checks carried out in areas such as the cleanliness of the premises, care documentation and the safety of the premises. A satisfaction survey had been carried out in July 2014. We noted that there was a high satisfaction level regarding the care and services provided.

We saw that a standard form had been introduced to guide and record staff supervisions. Training records showed that staff had received training in the areas identified and recorded in their supervision meetings.

We saw care plan audits which showed that the care plans of all 47 people living in the home had been audited at least once. Action had been taken to address any gaps identified. The four care plans we saw were complete, up to date, and had been reviewed every month.

These findings show that staff were supervised regularly and training needs were met. Accurate records were kept in relation to supervision, training and individual's care plans. This meant that arrangements were in place to protect people from the risks of unsafe or inappropriate care and treatment.

The provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. A relative felt their mother was safe here 'a thousand percent.'

A vacant care manager post over several months meant that staff had not received appropriate levels of supervision, contrary to the organisation's policy. We also found that training needs which had been identified sometimes fell through gaps. Some records relevant to the management of the service were not accurate or fit for purpose.

People said they had no concerns about the quality of care they received and their 'suggestions were welcome.' The provider involved people and undertook several audits aimed at improving the quality of care.