The Rubens

Updated 26 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Rubens is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement dependent on their registration with us. The Rubens is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, Healthwatch and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

During the inspection we spoke with seven people who use the service and five relatives about their experience of the care provided. We spoke with seven members of staff, this included care support staff, senior care staff and a cook. In addition, we with spoke with the registered manager and the deputy manager. We received feedback from two visiting health professionals. We reviewed a range of records. This included five people's care records and multiple medication records.

We looked at two staff files in relation to recruitment and staff supervision. In addition, we reviewed a variety of records relating to the management of the service, including policies and procedures.

Updated 26 October 2022

About the service

The Rubens is a care home without nursing care. The home accommodates a maximum of 26 people in one large building. At the time of our inspection 26 people lived in the home, some of whom were living with dementia. Care was provided over two floors. On the ground floor there were two lounges, a large dining room and a smaller dining area. Bedrooms were located on the ground and first floor; a lift was available to the first floor. There was an enclosed garden with seating areas for people and relatives to enjoy.

People’s experience of using this service and what we found

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Some people had not had Deprivation of Liberty Safeguards applications made which put them at risk.

Risks to people were not always assessed, managed or monitored safely. Risk assessments were not always completed for people’s specific risks and falls were not always recognised as incidents and sufficiently monitored. Care plans were not always kept up to date with people’s changing needs and support. Infection prevention control policies were not always followed regarding the environmental cleanliness and furnishings.

Staff had not received training around people's specific health conditions, such as diabetes. Several training courses had lapsed over time, meaning staff were due refresher training and some staff were waiting to attend courses.

The registered managers carried out quality assurance processes, including internal audits. However, these were not always effective in identifying the concerns we identified. This meant areas of improvement were missed which could potentially cause harm.

The provider acted quickly to the recommendations identified and has taken action to improve each area. These will be reviewed on the next inspection.

Medicines were managed safely by suitably trained staff and people received the medicines in a private and dignified way.

Staff used personal protective equipment (PPE) effectively and received infection prevention control training.

There were enough staff on duty to support people’s needs and staff were recruited safely.

Staff understood what was meant by abuse and they were confident about how to report their concerns.

People, relatives and staff told us they felt involved in the service and able to express their opinions and make suggestions to improve the care provided.

Visiting professionals told us the culture was person centred and they confirmed how the provider works in partnership to achieve positive outcomes for people.

People and relatives were complementary about the meals provided. They told us people had choices over their meals and could have drinks and snacks when they wanted.

People, relatives and staff were confident to raise concerns or complaints and told us they felt these would be listen to and acted upon.

People had confidence in the registered manager’s ability to lead the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 08 February 2019)

Why we inspected

The inspection was prompted in part due to concerns received about infection prevention control, incident monitoring and risk assessing concerns. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only. We inspected and found there was a concern with Mental Capacity Assessments and Deprivation of Liberty Safeguard (DoLS) referrals, so we widened the scope of the inspection to include the key questions of Effective.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report.

The provider acted during and after the inspection to mitigate the risks identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Rubens on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to gaining peoples consent, acting in people's best interests, and governance systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.