This inspection took place on 27 April, 29 April and 10 May 2016. The first day of the inspection was unannounced. This meant the registered provider did not know we would be visiting. The service was last inspected on 8 December 2014, found to be compliant with all regulations and rated ‘Good’.
Reuben Manor Care Home provides services for up to 83 older people who may be living with a dementia. Accommodation is provided over three floors, all accessible by two lifts and all bedrooms offer en suite facilities. The home has a number of communal lounges and dining areas and facilities such as a coffee shop and hair and beauty salon. There are landscaped garden areas surrounding the building with car parking available to visitors. At the time of our visit the top floor of the service was undergoing a refurbishment and there were 57 people using the service.
The service had a registered manager in place. 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 their relatives told us they felt that care was delivered safely.
There were systems in place to protect people from the risk of harm. Individual risk assessments were in place and covered key risks specific to the person such as moving and handling and falls. These documents were regularly reviewed and updated as required.
The service had an up to date safeguarding policy in place and staff had a working knowledge of this. They were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were also aware of whistle blowing procedures.
The service had policies and procedures in place to ensure that medicines were ordered, stored and administered safely. Accurate medicines records were kept and regular auditing of both records and stock took place.
Staff levels were calculated using a dependency tool and we saw there were more than sufficient numbers of staff on duty to support people’s needs.
Accidents and incidents were appropriately recorded and analysed so that any trends could be identified.
We saw that safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. The checks included obtaining references from previous employers and a Disclosure and Barring Service check to ensure that staff were safe to work with vulnerable people.
Appropriate maintenance checks had been regularly undertaken to ensure that the environment was safe. We saw up to date certificates in areas such as gas safety, fire equipment and portable appliance testing.
Staff received appropriate training and had the skills and knowledge to provide support to the people they cared for. This included specialist training specific to the needs of the people using this service. New staff underwent comprehensive induction training and mandatory training was refreshed regularly in line with the training policy.
Staff had a working knowledge of the principles of consent and the Mental Capacity Act. We saw evidence of capacity assessments being undertaken and best interest decisions being made. However, these were not always correctly worded or completed which meant that some of the decisions we saw were overly restrictive.
Staff received regular supervision and annual appraisals to monitor their performance and felt that these sessions provided a useful forum for discussion.
People were supported to access external health services such as dentists and opticians to ensure their general health and wellbeing. People were also referred to services such as the falls team or dietician where a need had been identified.
Kitchen and care staff were aware of people’s dietary requirements and any extra support needed at mealtimes. Records were kept to ensure people enjoyed a suitable, healthy diet and maintained a good level of nutrition.
Staff were friendly and patient when delivering care and were mindful of respecting people’s privacy and dignity. Staff were happy in their job and had a positive attitude about the care provided by the service. People using the service and their relatives felt the staff delivered a good standard of care.
End of life care plans were in place to inform staff of the person’s wishes and to ensure they were respected. We saw that information on advocacy services was available, although nobody was in need of an advocate at the time of our visit.
Care plans contained a good level of detail regarding people’s individual care needs and preferences. Plans were written in a person centred way which meant people received support tailored to their personal needs. People and their relatives were involved in care planning and reviews.
People were offered a variety of activities both inside and outside the service. Staff were aware of the risks of social isolation and visited those people who chose to stay in their room to provide one to one activities. Relatives were free to visit at any time and were made to feel welcome.
The service had an up to date complaints policy that was made available in a communal area. Complaints were properly recorded and fully investigated within the timescale stated in the policy.
There were a number of systems in place to monitor and improve the quality of the service provided. The registered manager carried out numerous weekly and monthly audits and findings from these were published in a monthly newsletter in order to promote openness and transparency. We saw that actions plans were put in place to address any issues identified.
Staff felt very well supported by management and colleagues and felt that they were able to voice their opinions and be listened to. The registered manager had an open door policy and held staff surgeries on a weekly basis. Feedback from staff was regularly sought via team meetings and staff surveys. Staff meetings were not always well attended but they were being held at various times of day in an effort to improve this.
The registered manager had built links with the local community, particularly with schools in the local area, and people using the service were involved with local charities.