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Inspection carried out on 22 March 2018

During a routine inspection

This inspection took place on 22, 23 and 28 March 2018 and was unannounced. At the last inspection on 24 and 27 January 2017 we found the service was in breach of six regulations as stipulated by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Inspection carried out on 24 January 2017

During a routine inspection

This inspection took place on 24 and 27 January 2017 and was unannounced. We last inspected the home on 27 January 2016 when we found the provider was in breach of three regulations, in relation to staff supervision, monitoring of changes in care records and meeting the requirements of Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). During this inspection we found that the provider had made adequate improvements in relation to providing regular supervision sessions to their staff team including conducting group supervision. However, care and monitoring records were not sufficiently detailed and accurate, in order to ensure that people’s needs were fully and responsively met. People using the service who were unable to give informed consent were not consistently protected by the home within the requirements of the MCA and the records related to them were not always accurately completed.

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

Inspection carried out on 27 January 2016

During a routine inspection

This inspection took place on 27 January 2016 and was unannounced. Rubens House is a care home that is registered to provide accommodation and personal care for up to 48 people. The home is run by Jewish Care, a voluntary organisation. There were 39 people living in the home at the time of this inspection.

The home did not have a registered manager as the previous registered manager was no longer working at the home. 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 an interim manager in place who advised that they would cover the home until a new registered manager was appointed.

Due to changes in management, and a large number of staff vacancies at the home, staff had not receive sufficiently regular supervision meetings in recent months to support them in their role. Agency staff were not provided with clear recorded induction and orientation information before working with people. People who were unable to consent to care did not have best interest decisions recorded for them, and deprivation of liberty safeguards were not in place for all people who required this.

Improvements were being put in place, however the majority of care records inspected for people living at the home did not include sufficient current and personalised information to ensure that their changing needs were addressed promptly.

The home was clean and there was a refurbishment programme in place. People told us that their care needs were met, and they were provided with their medicines safely. Action had been taken to reduce the number of agency staff working at the home with ongoing recruitment of permanent staff. Safe systems were in place for recruiting staff.

Staff training needs were assessed, with systems in place to make sure they had training in mandatory and other relevant areas. Staff showed a good knowledge of people’s life histories and preferences regarding their care and support needs. They were clear about the procedures for reporting abuse and felt that management listened to their views.

People were provided with a choice of food at all meal times, and were supported to eat when this was needed. They spoke positively about the food provision in the home. They were also satisfied with the range of activities available to them.

People’s health needs were met, and they were supported to consult with health and social care professionals as needed without delay. They had the opportunity to be involved in decisions about their care and how they spent their time at the home. They and their relatives attended meetings or spoke directly to a manager to raise any issues of concern.

The provider had systems for monitoring the quality of the service and engaged with people and their relatives to address any concerns. When people made complaints they were addressed appropriately.

At this inspection there were three breaches of regulations, in relation to staff supervision, the Mental Capacity Act 2005, and monitoring of changes in care recorded. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 16, 17 September 2014

During a routine inspection

A single inspector carried out this inspection. The inspection was carried out in response to concerns expressed regarding the premises, staffing arrangements and care provided at the home.

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.

Inspection carried out on 11 October 2013

During a routine inspection

This inspection followed up on our last inspection on 25 April 2013 when we found that staff supervision and training was patchy and care plan recording was incomplete. At our inspection on 11 October 2013 we found that the home had taken action to increase supervision and training levels and to improve the recording of people’s care needs and care that had been delivered.

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.

Inspection carried out on 25 April 2013

During a routine inspection

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person said “everything is explained.” Care plans provided a comprehensive assessment of people’s needs, preferences and risks.

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.

Inspection carried out on 12 July 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live in this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an

Expert by Experience; people who have experience of using services and who can provide that perspective.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

People who use the service told us that staff were kind and respected their privacy and promoted their independence.

People told us staff understood their needs and provided them with the care and support they needed in the way that they wanted. They told us their religious and cultural needs were met by the home, and staff spoke to them in the language that they understood.

People's comments about their experience of living in Rubens House included, "happy” with the service, “the service is very good”, staff “try very hard” and staff work “to the best of their ability”.

People told us that they had sufficient and suitable food and drink which met their dietary needs and preferences. People's comments and description of the meals included, "excellent chef”, “we have regular and substantial meals” and “different tastes each time”.

Many liked the social atmosphere and felt this promoted their independence and one person commented it was a "home away from home" and "that they had made a friend for life".

The home had effective systems in place to ensure that people were protected from abuse. They received the nutrition and health care they needed. Peoples' records were stored securely.

Inspection carried out on 20 July 2011

During a routine inspection

As part of this review We spent most of our visit observing and talking with people using the service. People told us staff treated them with respect and dignity. They told us they were involved in decisions about their care and treatment. We observed people were relaxed when interacting with staff. We saw staff addressing people in their preferred names. People who use the service made positive comments about their care and treatment. These included:

"Staff are nice".

"They are all kind".

"We are involved in activities".

We saw people were engaged with other people using the service and staff. They seemed to be enjoying their engagement with staff and other people. We saw staff coming to the lounge and dining room to support or engage with people. We asked people about their experience of living at the home. Many people told us they were well treated and satisfied with the care they were receiving. The following were some of the comments people using the service made:

"I couldn't wish for more".

"The attention is very good".

"The staff are wonderful".

People told us they enjoyed the meals provided in the home. They said if they did not like the food, they could ask and get what they wanted. People's comments included:

"The food is very good."

"If you don't like the food, they will cook for you; they never refuse."

"They look after us."

"I have no complaints."

We saw people eating their lunch. We saw people were able to choose from the menu. A person told us they had chosen what to eat and they were satisfied with their meal. We saw the chef going around in the dining hall and asking people if they enjoyed their meal. People told us he did this regularly and they told him what they felt about the food.

People who use the service told us that they felt safe, and would speak to staff or the manager if they had concerns. They talked positively about the staff. They said:

"The staff are all kind".

"I feel safe here".

Visitors informed us they could talk to the manager. They said the manager's door was always open for them and people using the service.

From conversations with and observation of people it was evident that they felt staff listened to them. We saw staff responding to people's suggestions. We observed staff talking and explaining to people about their care and treatment.

People talked positively about the home and the manager. They told us they could talk to the manager. They said the staff responded to their needs and they "had no complaints".