Archived: Rubens House

Updated 19 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22, 23 and 28 March 2018 and was unannounced.

This inspection was carried out by one inspector.

Prior to the inspection, we reviewed the information that we held about the service and the provider including notifications affecting the safety and well-being of people who used the service and safeguarding information received by us. We reviewed the Provider Information Return (PIR) which the provider had sent to us. A PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. We also looked at action plans that the provider had sent to us in March 2017, following the previous inspection.

We observed care and staff interaction with people in communal areas across the home, including medicines administration, breakfast and lunch in the dining room and a number of activity sessions that had been scheduled to take place. Some people could not inform us on their thoughts about the quality of the care at the home. This was because they could not always communicate with us verbally and we could not understand how they communicated due to their complex needs. Because of this we spent time observing interactions between people and the staff who were supporting them.

We looked at care records for nine people living at the service to see if they were up-to-date and reflective of the care which people received and ten people’s medicine administration records. We also looked at personnel records for six members of staff, including details of their recruitment, training and supervision. We reviewed further records relating to the management of the service, including staffing rotas and quality assurance processes, to see how the service was run.

During the inspection, we obtained feedback from four people and eight relatives. We spoke with the assistant director, the service manager, the registered manager, the care manager, three team leaders, four care staff, the chef, social care coordinator and a visiting rabbi.

Updated 19 May 2018

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 possible; the policies and systems in the service supported this practice.

Care plans contained appropriate documentation confirming consent to care had been obtained and where people lacked capacity, best interest decisions had been made and documented in partnership with the relevant involved individuals. Care staff were clearly able to explain their understanding of the MCA and DoLS and how this impacted on the care and support that they delivered.

People and relatives told us that they enjoyed the food at Rubens House. We saw plenty of drinks and snacks around the home that were available to people as and when they so desired. Where people were noted to have specific risks associated with their nutrition and hydration these had been clearly documented and appropriate measures had been implemented to monitor this.

Since the last inspection significant refurbishment work had been carried out to improve the environment of the home in order to make it more accessible and dementia friendly.

Records seen confirmed that staff received regular supervisions and annual appraisals as well as regular training to enable them to deliver safe and effective care.

We observed positive and caring relationships that people had developed with other people living at the home and with the entire staff team at the home. Issues noted with the use of agency staff had been addressed with the use of regular, known agency staff that regularly worked at the home.

Care plans were person centred and detailed. The provider was in the process of transferring all care plans on to an electronic care plan but this piece of work was being completed on a phased basis so as to minimise disruption. Detailed work had been completed around people’s life histories called ‘Remarkable Lives.’

As part of the electronic care planning system the service had already begun to record all daily living activities and monitoring onto the care plan. This included daily recording, food and fluid monitoring and activities participation. The electronic care plan was a live document that ensured entries of relevance were made at any time with reminders where a time lapse in recording had been noted.

Improved systems were in place to monitor and check the quality of care provided. We received consistently positive feedback from people, relatives and staff regarding the management structure in place, the support they received and the improvements that had been made.

The senior management team were always accessible to people, relatives and staff who spoke positively about them and felt confident about raising concerns.