• Care Home
  • Care home

Archived: Reuben Manor Care Home

Overall: Good read more about inspection ratings

654-656 Yarm Road, Eaglescliffe, Stockton-on-Tees, Cleveland, TS16 0DP (01642) 784189

Provided and run by:
Silk Healthcare Limited

All Inspections

6 November 2018

During a routine inspection

Reuben Manor is a residential care home for 83 people. Reuben Manor provides care and accommodation to younger adults and older people, including those living with a dementia. Accommodation is spread across three floors and the middle floor provides support to people with dementia.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good.

Staff knew how to keep people safe and reduce the risks of harm from occurring. Staff had completed training in safeguarding vulnerable adults and understood their responsibilities to report any concerns. Thorough recruitment and selection procedures ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were reviewed regularly. Medicines were managed safely and administered by staff trained for this role.

Staff received appropriate training and support. 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. People were supported to have enough to eat and drink and had access to healthcare professionals as and when this was needed.

Staff provided care and support with kindness and compassion. There were positive interactions between people and staff. People could make choices about how they wanted to be supported and staff treated them with dignity and respect. People's independence was promoted and encouraged. There was a welcoming and homely atmosphere at the service.

People received support which was person-centred and responsive to their needs. Detailed care plans were in place which guided staff how people wished to be supported with daily living. People were involved in writing and reviewing their care plans and in decisions about their care. There was a varied programme of activities and entertainment available to prevent people from being socially isolated.

People spoke positively about the registered manager and the wider management team. There was an effective quality assurance system in place to ensure the quality of the service and drive improvement. There were good systems in place for communicating with staff, people who used the service and their relatives to ensure they were fully informed of what was going on in Reuben Manor.

Further information is in the detailed findings below.

27 April 2016

During a routine inspection

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.

16 December 2014

During a routine inspection

We inspected Reuben Manor Care Home on 16 December 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

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, it also has a coffee shop, a bar and a hair and beauty salon located on the ground floor. There are landscaped garden areas surrounding the building with car parking available to visitors.

The home had a registered manager in place and they have been in post since the home opened over five years ago. 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 we spoke with told us they felt safe in the home and the staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.

People told us that the staff worked with them and supported them to continue to lead fulfilling lifestyles. Staff outlined how they supported people to continue to lead independent lives. We saw that on the units for people who experienced dementia, staff matched their behaviour to people’s lived histories (the time of the person’s life they best recall) and this enabled individuals to retain skills and work to their full potential.

We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. Those people who were able to were encouraged and supported to go out independently and others routinely went out with staff.

People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. Two nurses and 16 care staff were on duty during the day and a nurse and 10 staff on duty overnight. We found information about people’s needs had been used to determine that this number could meet people’s needs.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. A designated infection control champion was in post and we found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

Staff had received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia and Parkinson’s disease. We found that the registered manager not only ensured staff received refresher training on all training on an annual basis but routinely checked that staff understood how to put this training into practice. Each month the manager questioned staff about different aspects of the courses and when staff struggled to find the correct answer they ensured staff received additional training.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training and clearly understood the requirements of the Act which meant they were working within the law to support people who may lack capacity to make their own decisions. We found that the staff had the skills and knowledge to provide support to the people who lived at the home.

People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice. We observed that staff had developed very positive relationships with the people who used the service. Where people had difficulty making decisions we saw that staff gently worked with them to work out what they felt was best. We saw that when people lacked the capacity to make decisions staff routinely used the ‘Best Interests’ framework to ensure the support they provided was appropriate.

We saw that the staff were able to discreetly support people to focus on the task at hand, which we found reduced the impact of the difficulties people experienced with impulse control and anger management. Staff also sensitively supported people to deal with their personal care needs.

The interactions between people and staff that were jovial and supportive. Staff were kind and respectful, we saw that they were aware of how to respect people’s privacy and dignity.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.

The registered manager received daily updates on all the people who used the service and demonstrated a significant depth of understanding about each person. We met the owner and found they also had intimate knowledge of each person’s needs.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. The registered manager had ensured people were supported to access independent advocates when needed. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

Regular surveys, resident and relative meetings were held and the registered manager also conducted a weekly surgery so people could drop in and speak with them. We found that the analysis of the surveys showed the majority of people believed the home delivered an outstanding service and this view was echoed in our discussions with people during the visit.

The provider had developed a range of sytems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.

17 December 2013

During a routine inspection

We spoke with nine people who lived at the home, three relatives and five members of staff. People who lived at the home told us, "I was surprised at how much there was to do here, I choose not to take part but there is always plenty going on" and "I feel completely safe here, I am very happy." Relatives told us that they have peace of mind knowing that their family members are being looked after. One relative told us, "They are really content and happy here."

Staff told us that they were happy in their work at home. They said, "We have a great family atmosphere, we all work well together", "Since I started I have received lots of training" and "People are looked after well here."

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

We did find that accurate and appropriate records were not maintained.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises and there were enough qualified, skilled and experienced staff to meet people's needs.

14 December 2012

During a routine inspection

We spoke with six people who used the service and the relatives of three people. We also spoke with the manager, assistant manager and six staff. People who used the service expressed satisfaction with the care and service that they received. One person told us; 'There are always staff around to help'. One of the relatives we spoke with told us; 'I have no concerns, they look after mum well'.

Where able, people could make their own day to day decisions and lifestyle choices. They could choose to participate in activities or spend time in their rooms. We saw people could maintain contact with their friends and family.

We saw there was a friendly and relaxed atmosphere between people living and working at the home. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing. People's views were taken into account in the assessment and care planning process.

There was a range of equipment available to meet people's individual care needs.

We found there were appropriate arrangements in place for the recruitment of staff.

The quality of the service was monitored and reviewed on a regular basis.

17 January 2011

During a routine inspection

During our visit people who used the service told us 'They do everything that I can't do for myself, they ask me what I want'. One person said, 'The staff are friendly and helpful and yes I think there is enough staff'. Another person said, 'It is my personal choice to remain in my room, I like my own company, I have this buzzer, I only have to ring and they will come, yes it is answered promptly'.

People also said 'The staff are all good' and 'It is comfortable, warm, staff couldn't be any better, very nice, very kind'.