Yad Voezer 2

We found the following examples of good practice.

We were somewhat assured that this service met good infection prevention and control guidelines as a designated care setting.

¿ The service had access to Covid-19 testing kits and carried out regular testing of all staff and people using the service, including agency staff members.

¿ Agency staff were regularly used by the service and given permanent shifts to ensure they did not work at other services thus reducing the risk of the spread of Covid19.

¿ Daily Infection prevention and control (IPC) audits were carried out by the manager to ensure staff maintained good IPC practices. Cleaning schedules were monitored to ensure surfaces and designated areas were clean.

¿ Designated hand washing facilities were available at the service.

¿ The layout of the building and space enabled people to follow social distancing guidelines, we observed staff complying with these guidelines during our visit.

¿ The service used various methods of communication when discussing Coronavirus with people living at the service. This included, using objects of reference, such as showing people a mask to explain why they needed to wear them when they went out in the community and staff sang to encourage people to wash their hands using good hand washing techniques.

Further information is in the detailed findings below.

Yad Voezer 2 is a residential care home providing accommodation with personal care to up to a maximum of eight people with learning disability or autistic spectrum disorder. At the time of our inspection there were six women living at the service. One of the bedrooms was used for respite care which was vacant at the time of our visit. The home accommodates women only and the provider has a neighbouring home for men, located nearby. Apart from the registered manager, all staff are female.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

People and relatives told us they were safe, and staff treated them well. Risk assessments detailed how to support people to minimise risk. Staff had been recruited safely. Systems and processes were in place to support staff to understand their role and responsibilities to protect people from avoidable harm.

There was a process in place to report, monitor and learn from accidents and incidents. People were protected from the risks associated with poor infection control as there were processes in place to reduce the risk of infection and cross contamination. There were systems in place to ensure proper and safe use of medicines.

People were cared for by staff who received appropriate training to effectively carry out their role. Staff worked with professionals to support people’s care needs. People were asked for their consent before care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People’s nutritional and hydration needs were met by the service. The service worked with other health and care professionals to meet people’s health needs.

People’s needs were assessed prior to joining the service. Care plans documented people’s preferences, likes and dislikes. People’s communication needs were documented in their care plan. Staff were caring, kind and spoke attentively to people.

People were supported by staff who knew people well. People were supported to maintain their independence and their dignity was valued and respected.

People were supported to participate in activities and follow their own interests. People and relatives knew how to raise a concern if they were unhappy about the service they received.

There were systems in place for monitoring the quality of the service. The provider knew what was expected of them in terms of Duty of Candour, they had spoken with the local authority and relatives concerning incidents at the home.

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 Requires Improvement (published 21 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yad Voezer 2 on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last planned comprehensive inspection on 28 June 2017 and 4 July 2017, we found the provider in breach of Regulation 18 of the Registration Regulations 2009. This was in relation to the reporting of notifiable incidents to the CQC, the provider failed to report two safeguarding incidents as required by law. We also made three recommendations relating to complaints, the updating of policies and procedures and updating of information contained in support plans. The service had an overall rating of Requires Improvement. We rated Safe, Responsive and Well-led as Requires Improvement and Effective and Caring as Good.

During this inspection we found the provider had made some improvements, policies and procedures had been updated and care plans reviewed. Although the provider had submitted notifiable significant incidents, we found that we had not been notified of three incidents involving the police and a person receiving respite care from the service. This meant that we did not have important information about the service to effectively monitor people's safety and wellbeing. We are considering what action we may need to take to address this.

Yad Voezer 2 is a ‘care home’ for members of the Orthodox Jewish faith. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Yad Voezer 2 accommodates up to a maximum of eight people with a learning disability or autistic spectrum disorder. At the time of our inspection there were six women living at the service. One of the bedrooms was used for respite care which was vacant at the time of our visit. The home accommodates women only and the provider has a neighbouring home for men, located nearby. Apart from the registered manager, all staff are female.

The service had a registered manager. 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 felt safe with staff and comfortable approaching staff with any concerns. People were protected from the risk of abuse. Staff knew what constituted abuse and understood their responsibility to report abuse. Staff were aware of the whistleblowing procedure and reporting any concerns to external authorities.

Risk assessments identified risks and actions to mitigate these. Staff understood about risk management and how to manage behaviours that challenged the service. We found recruitment practices were not always followed to ensure staff were safe to work with people. We found gaps in references and criminal record checks.

Staffing numbers were based on level of need, but we made a recommendation about reviewing staffing.

Medicines were managed safely and systems in place for auditing and checking how medicines were being administered. Individual Pro Re Natan (PRN) medicine to be given when required protocols were not in place to guide staff on when to administer PRN.

People were protected from the risk of the spread of infection because staff followed infection control practices when providing care, including the use of personal protective equipment (PPE).

There were systems in place for reporting and recording incidents and accidents and learning from incidents took place. However, these incidents were not always reported to the CQC.

Safety checks were carried out to ensure the building was safe for people using the service, however, we found urgent repairs were not always carried out in a timely manner.

Staff received an induction which including mandatory training relevant to their roles. Staff received supervision which included a review of their performance and training needs. Staff also took part in yearly appraisals to assess their performance and set goals for the coming year.

People’s nutrition and hydration needs were met and people were provided with a choice of meals that met their religious and cultural needs. People’s spiritual and cultural beliefs were respected and staff supported people to celebrate their Jewish faith.

Staff worked within the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were given choice and staff asked people for their consent before providing care.

People had access to healthcare professionals to ensure that their health needs were met and well-being maintained.

Staff treated people with dignity and respect and staff encouraged people’s independence. People’s confidentiality was respected and records relating to people using the service were kept in a lockable cabinet.

The atmosphere at the home was warm and welcoming which gave it a homely feel. We observed people were comfortable with staff who were caring and kind. The service operated an open-door policy which enabled people to approach staff whenever this was needed.

People had care plans which were personalised and detailed how care should be delivered. Care plan reviews took place, however, we found review dates differed which made it difficult to know which plan was the most up to date, also information was not always updated to reflect people’s current needs.

The service responded to complaints and staff supported people to make a complaint if they were unhappy with the service. A copy of the complaints procedure was displayed on the communal notice board in easy read pictorial format. This made it more accessible to people using the service.

Quality assurance systems were in place to monitor the quality of the service and audits took place. However, these audits were not always effective in identifying some of the issues found during our inspection. Care records were not always up to date or accurate and the provider failed to notify the CQC of significant incidents. Several changes in senior management at the service meant that governance and overall management of the service lacked consistency.

We found four breaches of Regulations. This was in regards to the provider informing us about significant incidents at the service, safe care and treatment and good governance. We have made two recommendations. These are in relation to managing behaviours that challenged the service and management of staffing hours.

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

We conducted an unannounced focussed inspection on 4 April 2017 to check that the provider had acted on the recommendation and we also looked at whether other improvements were made in relation to issues we had identified within safe and well-led. At the focussed inspection we found that the provider had improved the quality of the cleanliness in accordance with the recommendation, and the issues within safe and well-led had been satisfactorily addressed. Measures had been taken to improve how risk assessments were developed, new procedures had been implemented to ensure that medicines were stored at correct temperatures and obsolete documents had been removed from people’s folders so that relevant information was easily accessible. Following the focussed inspection we could not improve the ratings for safe and well-led from requires improvement, because to do so requires consistent good practice over time. The provider was advised that we would make these checks during our next planned comprehensive inspection.

The service is registered to provide care and accommodation for up to eight people with a learning disability or autistic spectrum disorder. At the time of this inspection, there were six women living at the service. We were informed that one bedroom is ordinarily used to provide short breaks or respite care which was vacant when we visited. The home is for women only and the provider has a separate care home for 10 men, which is located on the same street. All of the staff and volunteers are female, apart from the registered manager. People who reside in the home are members of the Orthodox Jewish faith.

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 registered manager in post, who also managed the nearby service for men. He was present during the inspection and was supported by a deputy manager, who was permanently based at Yad Voezer 2.

Staff understood how to identify different types of abuse and report their concerns to their line manager. The provider’s whistleblowing policy advised staff of how to report any concerns about the conduct of an employee, manager or volunteer by using the organisation’s internal structures or through external reporting to other relevant authorities. However, we found that the registered manager had not appropriately notified the CQC about two safeguarding allegations, as required by law. This meant that we did not have important information about the service to effectively monitor people’s safety and wellbeing.

Individual assessments were in place to promote people’s independence and mitigate identified risks to their safety and welfare. Staff had been safely recruited which ensured, that as far as possible, they were suitable to work with people who use the service. Records showed that staff had completed medicines training and had the appropriate knowledge and skills to safely follow the provider’s medicines policy and procedure.

Checks were made to ensure that people were provided with a clean, hygienic and safely maintained home.

The provider’s training programme took into account the mandatory training that staff needed and training that was bespoke to the needs of people who use the service. This included specialist training from a speech and language therapist to meet people’s individual needs. Systems were in place to support staff with their roles and responsibilities, for example there were regular team meetings and an individual annual appraisal. The delivery of one to one formal supervision was noted to be limited last year; however the supervision schedule for 2017 indicated that there was a more rigorous approach in place to ensure that supervision was conducted approximately once every two months.

Staff had received training in regards to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Discussions with the registered manager showed that he liaised appropriately with the local authority to discuss whether people needed to be referred for a DoLS assessment and how to implement the least restrictive approaches. We noted that the there was insufficient information on a person’s file to determine if there were legal arrangements in place for other parties to act on their behalf.

People were provided with a choice of meals that met their religious and cultural needs. Where necessary people received diets and support with eating and drinking in line with their assessed health care needs and where relevant, guidance from applicable health care professionals.

Records showed that people were supported to attend health care appointments. People’s care and support plans recorded how staff responded to any specific instructions issued by health care professionals to assist people with their health care needs and promote their safety and wellbeing.

We observed that there was a homely ambiance and people seemed at ease with staff. The provider met people’s needs in relation to their faith and their participation in the celebration of events and festivals that were important to them. Staff were observed to be caring and thoughtful and they had received training about Jewish traditions, where applicable. People were supported in a manner that respectfully maintained their dignity and privacy.

The care and support plans were being developed by the registered manager at the time of the inspection in order to ensure that information was always accurate and reflected people’s needs and wishes in a more person centred way. The registered manager intended to complete this task a few weeks after the inspection.

The provider's policy for managing complaints appeared very outdated and needed to be replaced with a more current version. The one complaint received by the service in the past two years had been satisfactorily investigated.

Staff told us they felt supported by the registered manager, and both the registered manager and the deputy reported that the provider supported their managerial and development needs. We found that although there were systems in place to monitor health and safety practices within the home, we did not find evidence of other quality monitoring methods. It was noted that quality surveys had not been sent to the relatives of people who use the service for over two years and unannounced visits by the provider and the service's management team did not result in the production of any monitoring reports.

New protocols had been introduced to record how people were supported with their financial allowances.

The provider has been given written information in order to liaise with the CQC about its current registration status.

We found one breach of Regulations. This was in regards to the provider informing us about significant incidences at the service, in accordance with regulations. We have made three recommendations. The first is in relation to the reviewing of people’s files to ensure that correct information is held to determine if people have appointed deputies or attorneys in accordance with the Mental Capacity Act 2005 (MCA). The second recommendation is in relation to complaints management and the third recommendation is in regards to the provider updating policies so that they are applicable to current guidance and good practice.

You can see what action we asked the provider to take at the back of the main report.

This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Yad Voezer 2 on our website at www.cqc.org.uk.

Yad Voezer 2 is an eight bedded care home for people with a learning disability. The care home is for women only and all of the staff team and volunteers, apart from the registered manager, are female. At the time there were six women living at the service. People who reside at the service are members of the orthodox Jewish faith. Non-Jewish staff are supported to learn about the faith so that they can support people appropriately.

There was a registered manager 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 this inspection we found that the provider had improved the quality of the cleanliness and provided people with a hygienic and comfortable environment. Measures had been taken to improve how risk assessments were developed, to ensure that there was clear information about the nature of the risks and the actions required to mitigate the risks. The provider had implemented new procedures to ensure that people’s medicines were stored at correct temperatures, in line with pharmaceutical guidelines.

We noted that the provider had removed obsolete documents from people’s folders, so that staff and external professionals could consistently access current and relevant information. People’s records had been updated to ensure that any changes were reflected on all necessary documents. We were not in a position to check whether additional information had been added to people's records to clearly demonstrate whether there was a Deprivation of Liberty Safeguard authorisation in place, as the necessary documentation was not available on the day of the inspection. We will check this at the next comprehensive inspection.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed, and the records we looked at. If you want to see evidence that supports our summary please read the full report.

We spoke with three people who used the service, the acting registered and deputy managers, three staff members and four family members. Whilst we were able to speak with people, our conversations were limited because of their complex health conditions. We reviewed the care plans of three people.

This is a summary of what we found:

Is the service safe?

Three of the 12 members of staff had received safeguarding and whistleblowing training in the last three years.

Systems were in place to ensure staff learnt from events such as accidents and incidents.

We saw all people had care folders containing information related to their care and all staff had individual staff files.

During our inspection we assessed how the Mental Capacity Act (MCA) 2005 was being implemented. This is a law which provides a system of assessment and decision making to protect people who do not have capacity to give consent. We also looked at Deprivation of Liberty Safeguards (DoLS). DoLS aim to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. We saw that some people were unable to leave the home without the assistance of staff. This may mean deprivation of liberty authorisations were required. We saw no applications for DoLS had been made although in May 2014 a social worker had requested an application was made.

We have asked the provider to tell us how they will make improvements and meet the legal requirements in relation to safeguarding adults.

We looked at the recruitment of new staff. We found that some required checks were not always carried out before staff started work.

We have asked the provider to tell us how they will make improvements and meet the legal requirements in relation to staff recruitment.

Is the service effective?

We observed from speaking with staff and watching how they communicated with people that staff had an understanding of people's care and support needs, and knew them well.

Staff assessed people's health and care needs with the person and their family members. Staff told us care plans assisted them to meet people's needs. People's preferences, interests and diverse needs were recorded, and care and support was provided in accordance with the wishes of people using the service and their families.

Is the service caring?

All family members told us they felt their family member was safe in the care of staff.

Staff showed patience and gave encouragement when supporting people. One person said, 'Staff are very good, they're the best.' Another person said, 'Staff look after me.' One family member said, "Staff are excellent, no reservations,' another family member said they were, 'Very kind' and a third family said they were, 'Fine.'

Is the service responsive?

We saw information in care plans included risk assessments; however, there were shortfalls in keeping accurate records. People's care plans and risk assessments were not always up-to date and accurate to meet their care needs.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to assessing people's needs accurately to reflect their risk assessments and care plans.

People took part in activities within the home and the wider community.

All family members told us they knew how to make a complaint. We saw there was a process in place to respond to any issues of concerns.

Is the service well-led?

This small service has quality assurance systems to identify and address issues. We saw people who used the service their representatives and staff were asked for their views about their care and treatment.

The provider assessed people's individual needs and preferences to ensure their care was safe and people's rights were protected. Staff obtained people's consent before providing care. The person we spoke with said they liked living at the home. They said, 'I can choose what I have. My room is looking good.' We saw that people using the service freely approached and interacted with staff members and staff responded promptly to people's requests. There were a range of activities on offer at the home including daily support to meet people's religious and cultural needs.

The staff encouraged people to feedback their views about the service including any concerns or complaints. The provider acted on people's feedback.

The home was clean and well maintained. There were enough staff to support people living at the home. Staff members told us they were well trained and qualified for their roles and we also saw staff training certificates.