Archived: Clara Nehab House

At the time of our inspection there were 22 people living at the service. The service was located in two adjoining houses on a residential street with access to a back garden. There was a lift to access upstairs and there were accessible bathing facilities for people with mobility problems.

We previously inspected the service on 13 January 2017 when we found repeat breaches of the regulations in relation to the safe management of medicines and the recruitment of staff. Following the inspection in January we served the provider with two Warning Notices in relation to the repeat breaches. This inspection was carried out to review actions taken in relation to the Warning Notices and to also undertake a full comprehensive inspection of the service.

At the time of the inspection, there was a registered manager in place at the service. 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 were happy living at the service and we saw kind and caring interactions between staff and people living at the service on the day of the inspection.

We found recruitment processes had improved and appropriate references and checks were now in place prior to staff starting work at the service.

Medicines were now safely managed at the service.

Staff understood people’s needs and preferences and told us they were supported in their role. Supervision had been taking place more regularly since January 2017 and we could see that refresher training was planned for staff. Although staff understood about safeguarding and consent their understanding was not always appropriate to their role within the service.

Care records were up to date and staff had appropriate information to support people living at the service.

There was a range of activities at the service and people enjoyed participating in both collective and individualised activities and trips out.

People were supported to maintain good health through regular access to healthcare professionals such as GPs and the local general hospital.

People were happy with the range of food available. People’s cultural and religious needs were facilitated by staff.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We found the service to be compliant with the legislation.

Quality assurance audits were now taking place in a number of key areas and we could see that the registered manager had made improvements to the service following the warning notices issues earlier in the year. The service was no longer in breach of the regulations relating to the safe management of medicines or the recruitment of staff.

There was a record of essential services such as gas and electricity being checked, and equipment was safely maintained. There was clear documentation relating to complaints and accidents and incidents.

We saw fire drills were now taking place regularly and staff had received training in fire safety. Since January 2017 the provider had commissioned a fire safety consultant to work with the service.

We have made recommendations in relation to safeguarding and following best practice in relation to head injuries.

We inspected Clara Nehab House on 13 January 2017 to check if the service was now meeting requirements of the regulations. The inspection was unannounced. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clara Nehab House on our website at www.cqc.org.uk.

Clara Nehab House is a care home registered for a maximum of 25 people of the Jewish faith. At the time of our inspection there were 22 people living at the service. The service was located in two adjoining houses on a residential street with access to a back garden. There was a lift to access upstairs and there were accessible bathing facilities for people with mobility problems.

At the time of the inspection, there was a registered manager in place at the service. 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.

At the inspection in June 2016 we found there was a warm and friendly atmosphere at the service. People using the service told us they found the staff were caring and kind and were skilled enough to do their job. Relatives spoke highly of the service and would recommend it without hesitation to other people.

At this inspection we found the staff were kind and caring. People told us they felt safe living at the home and staff treated them with dignity and respect. They also told us they thought staff were effective in their caring role. Relatives continued to be happy with the home and the care provided to their family member.

At the inspection in June 2016 we found there was a breach of the regulations in relation to medicines. We found there were discrepancies between the number of tablets in boxes and what the records stated there should be, and boxed tablets were stored without their packaging which was a safety concern.

At this inspection in January 2017 we found that boxed tablets were now stored with their packaging, but there were still discrepancies between the number of tablets in boxes versus records.

At the inspection in June 2016 we found there was a breach in the regulations in relation to staff recruitment. Not all checks and references were obtained prior to staff being recruited permanently. This meant the service could not be confident staff were considered safe to work with vulnerable people.

At this inspection in January 2017 we found that whilst all staff had Disclosure and Barring Service (DBS) certificates in place at the start of working, not all staff had two references on their records when they started working at the service. Where verbal discussions had taken place with referrers to check a person's suitability for the role, records were not kept. This meant the service could still not evidence they were employing staff who were considered safe to work with vulnerable people.

At the inspection in June 2016 and in January 2017 staff talked positively about their jobs telling us they enjoyed their work and felt valued. Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm.

At the last inspection in June 2016 we found there were not safeguarding alerts completed if there were assaults between two people living at the service, despite the safeguarding policy stipulating this needed to be done. This meant that the local authority and the Care Quality Commission were not alerted to these incidents. Between the inspection in June 2016 and January 2017 notifications had been received by CQC and referrals made to the local safeguarding team in the event of a person living at the service assaulting another person living there.

At the inspection in June 2016 we noted that risk assessments would benefit from further personalisation to support staff in managing people’s risks most effectively. At this inspection the registered manger showed us a report by a dementia specialist who planned to work with the service from February 2017 whose remit was to work with staff and assist in the personalisation of risk assessments and care plans.

At the inspection in June 2016 we noted there had not been a fire drill for over a year. Since then there had been an unscheduled evacuation of the building due to a fire alarm being triggered by building work, which was managed safely. There had been fire safety training for staff since the last inspection and the registered manager told us a fire safety consultant was scheduled to advise the service in the future although there was no confirmed date for this work.

At the last inspection the registered manager told us they were considering options for additional staff support at night and hoped to increase staffing levels to three people at night on a permanent basis. At this inspection we could see three people were now working at night on a regular basis.

At the time of the inspection in June 2016 there was some work being undertaken to improve the facilities at the service. We found the premises were clean and tidy, although the décor was dated. At this inspection we found that the heating system had been upgraded and 22 people’s bathrooms had been renovated. The registered manager told us there remained work outstanding on three more individual people’s bathrooms and some of the communal bathrooms. Some areas were in need of painting. We were told there were plans to further renovate the service in the coming year.

At the inspection in June 2016 we found food was stored and labelled safely and in line with kosher requirements, and this remained the case at the inspection in January 2017.

At the inspection in June 2016 and in January 2017 we checked the management of people’s money and found it was safely managed.

At the last inspection there was a record of essential services such as gas and electricity being checked, and equipment safely maintained. The inspector did not review the information at this inspection.

People living at the service and their relatives and friends told us that the registered manager and deputy manager had a very visible presence within the home and dealt with any issues as they arose.

There remained two breaches of the regulations relating to staff recruitment and medicines at this inspection. CQC is considering the appropriate regulatory response to resolve the problems we found and will report on this when completed.

At the time of our inspection there were 24 people living at the service. The service was located in two adjoining houses on a residential street with access to a back garden. There was a lift to access upstairs and there were accessible bathing facilities for people with mobility problems.

We previously inspected the service on 3 April 2013 and the service was found to be meeting the regulations inspected.

At the time of the inspection, there was a registered manager in place at the service. 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.

There was a warm and friendly atmosphere at the service. People using the service told us they found the staff were mostly caring and kind and were skilled enough to do their job. Relatives spoke highly of the service and would recommend it without hesitation to other people.

Staff talked positively about their jobs telling us they enjoyed their work and felt valued. The staff we met were caring, kind and compassionate and treated people with dignity and respect.

We saw that care plans were up to date, and whilst there was significant recording related to people’s care and observations re their needs, this was not always translated into specific actions to mitigate risks on the risk assessments.

People were supported to maintain good health through regular access to healthcare professionals such as GPs and the local general hospital. In general people spoke well of the food, and we saw there was a plentiful and varied range of meals available. People’s cultural and religious needs were facilitated by staff.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We found the service to be compliant with the legislation.

At the time of the inspection there was some work being undertaken to improve the facilities. We found the premises were clean and tidy, although the décor was dated. There were plans for upgrading en suite facilities in people’s rooms and for carpets to be replaced. However, the walls were in need of painting, the flooring in communal bathrooms was dated and the kitchen facilities had limited preparation and storage facilities. The service had achieve the highest rating for food hygiene.

There was a record of essential services such as gas and electricity being checked, and equipment safely maintained. There was clear documentation relating to complaints and incidents.

People living at the service and their relatives and friends told us that the registered manager, and deputy manager had a very visible presence within the home.

We found staff supervision was being carried out on an irregular basis for some staff due to shortages at a senior level, however, group discussions were taking place in relation to key issues. Training was undertaken and staff said they felt well supported in their role.

Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. Staff and people using the service told us they felt confident any incidents or allegations would be fully investigated. Whilst we found that actions were taken when there was an incident of a person living at the service hitting another person this was not considered as a safeguarding incident in line with the provider’s policy. We have made a recommendation in relation to this.

We found there was a breach of the regulations in relation to medicines. People told us they had their medicines on time and they were stored in a locked room. However we found some discrepancies between the number of tablets in boxes and what the records stated there should be, and boxed tablets were stored without their packaging.

We found there was a breach of regulation in relation to staff recruitment. The service operated a policy of staff starting working with the service on a ‘casual’ basis. Not all checks and references were obtained prior to staff being recruited permanently. This meant the service could not be confident staff were considered safe to work with vulnerable people in the period when working casually at the service.

You can see what action we told the provider to take at the back of the full version of the report.

During our last routine inspection in November 2012 we had concerns regarding the provider's recruitment process. During this inspection we found that improvements had been made. The provider had reviewed their staff files and identified where staff were working longer hours than permitted by their visas. A system of regular checks on staff files had been implemented.

We identified concerns regarding the recruitment process. Evidence from staff files showed that some staff that were employed on student visas which had expired. We also found evidence that some staff that had been employed on student visas were working more than the allowed hours.