An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?At the time of our inspection six people were living at Tova. Although we spoke with people who use the service, they did not use verbal communication, and so were unable to inform us verbally of their opinions of the care they received. We observed their support and interaction with staff, and used this information to inform us about their care experience. As part of this inspection we also spoke with two people's relatives, the registered manager, a deputy manager and three care workers. We reviewed records relating to the management of the service, including three people's care plans and daily care records.
Tova is one of a group of residential homes providing care and support to people within a village environment known as Ravenswood Village. It was run primarily for those of Jewish faith, but people and staff did not have to be Jewish to live or work there. People were supported to practice their faith, and the village celebrated Jewish rituals and festivals. People had the choice of whether they wished to attend the synagogue or follow Jewish rituals.
Below is a summary of what we found. The summary describes what people using the service, their relatives, the staff and our observations told us, and the records we looked at.
Is the service caring?
One relative told us 'The care in Tova is excellent'. Another relative told us 'I am overwhelmed with the fantastic care X receives'. One deputy manager told us 'We are all comfortable with each other, and chat together, staff and residents'. Care workers we spoke with often referred to the service as 'Our family'.
We saw staff involved people in chat and activities in the service, and recorded people's reactions to meals and activities. This helped them to assess people's enjoyment or otherwise, and alter meals and activities according to people's preferences.
Staff were respectful when supporting people, and took care to promote their dignity. They assisted people in accordance with their care plans, but encouraged people to be as independent as possible, through choice and supported tasks and activities.
Is the service responsive?
We observed that the service was responsive to changes in people's needs or wishes. Staff understood people's gestures, facial expressions and vocalisations. This helped them to understand when people were happy, anxious or in pain. Staff responded promptly if they thought people were not satisfied with their care, or if their health or wellbeing had been compromised.
Care plans documented people's care needs and wishes. We saw that care plans had been updated when people's needs or wishes had changed. For example, if medication was altered by the GP, staff documented any changes to the person's mood or behaviour, and addressed issues identified with the support of health professionals. This meant staff responded quickly to promote people's health and wellbeing.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke with the registered manager who demonstrated that they were aware of the recent case law in relation to DoLs, and were reviewing whether applications for people were required with this in mind.
Is the service safe?
One relative told us 'I couldn't want better care for X'. They stated they believed their loved one was in safe hands. Staff understood each person's health and support needs, and communicated effectively to ensure changes had been documented and were known by all staff.
Staff had been trained to support people safely, and we observed they followed guidance provided by health professionals, such as the speech and language therapist. This meant that risks had been identified and assessed. Measures were in place to reduce the risk of harm to people and others.
Staffing levels were sufficient to meet people's needs and wishes. We saw that people's dependency needs had been assessed, and there were sufficient staff on duty to meet these.
Equipment was maintained and serviced in accordance with the manufacturer's guidance. Care workers had been trained to use the equipment provided, and were competent in its use. This meant that people had been protected from potential risks caused by poorly maintained equipment or its inappropriate use.
Is the service effective?
We found the service was effective. They sought feedback from people and relatives, and acted on the information received. For example, we saw meals and activities had been planned in accordance with people's known preferences, but had been changed in response to their reactions if they indicated displeasure.
The provider had systems in place to assess and monitor the quality of the service provided. They identified, assessed and managed risks to the health, safety and welfare of people who use the service and others. Reviews and audits of documents, internal checks, equipment servicing and staff learning ensured people were supported safely.
Is the service well led?
We found the service was well-led. Relatives and staff spoke positively about the registered manager. Staff told us they felt supported, and understood the provider's policies and health professionals' guidance. They said they had appropriate training and support to understand their roles and responsibilities.
We saw the provider's guidance, policies and procedures were available on line and where appropriate had been displayed in the service. This meant that staff had access to protocols to promote the safety and wellbeing of the people they supported.