Inspection on 01/08/05 for Rubens House

This inspection was carried out on 1st August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rubens House 06/11/06

Rubens House 06/02/06

Rubens House 23/02/05

Rubens House 31/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rubens House 184 Ballards Lane Finchley London N3 2NB Lead Inspector Margaret Flaws Unannounced 01 August 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rubens House Address 184 Ballards Lane, Finchley, London N3 2NB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8349 9879 020 8343 4173 Simon Morris for Jewish Care Mrs Kok Ying Idelbi PC Care Home only 51 beds Category(ies) of DE(E) Dementia over 65 registration, with number OP Old Age of places Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23 February 2005 Brief Description of the Service: Rubens House is registered to provide personal care and support for a maximum of 51 older people, some of whom may have dementia. The home is owned and managed by Jewish Care in accordance with Jewish culture and beliefs. Jewish Care operates other care homes in the London area. The building is a large detached four-storey house built in the 1960’s. There are two passenger lifts, which serve all floors. The ground floor contains two large dining rooms, two lounges, laundry, kitchen, staff room, an administration area and the manager’s office. Service users’ bedrooms are located on the first, second and third floors. There are two double bedrooms, one of which has en-suite facilities. There are 50 single bedrooms, 22 of which have en-suite facilities. All others have a washbasin.There are 14 toilets, 7 assisted bathrooms and 2 showers, located throughout the building. A treatment room, containing the medication cupboard is located on the third floor. There is a parking area at the front of the premises and a large garden at the rear, which is partly paved.A company called “Eurest”, provides the hotel and maintenance services. However, the manager has considerable management responsibility for these staff. The home is situated on Ballards Lane, a busy trunk road between North and Central Finchley. There is a wide range of shops, pubs and restaurants nearby and there is good access by public transport. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted approximately seven hours. It was undertaken by Inspector Margaret Flaws, assisted by Pharmacy Inspector, Marilyn McKenzie, as part of the routine schedule of inspections for the home. The care manager and thirteen staff of Reubens House were spoken to on the day of the inspection. The inspector was also able to speak to eight service users. No relatives visited during the inspection. A tour of the buildings and grounds, inspection of service user files, staff records, general home records and policies and procedures formed the basis of the inspection. The inspector also had lunch with three service users. Comment cards were received from nine service users, eighteen relatives, and four health professionals. Seven new requirements were made on this inspection and none were restated from the last inspection. What the service does well: What has improved since the last inspection? At the last inspection, there was one requirement – that a fire safety assessment and compliance with its recommendations was required. The Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 6 LFEPA have completed an assessment and work to meet their recommendation was being carried out at the time of the inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 Service users can be satisfied that the home has a formal process of assessment and trial visits for them to determine suitability and appropriate levels of care. EVIDENCE: The case notes sampled contained comprehensive assessments. All referrals are intially assessed by a panel from Jewish Care and a trial visit follows. The prospective service user is then assessed by the Rubens House Care Manager and mutual suitability is determined. The home does not provide intermediate care. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Service users can be assured that their care is well planned and reviewed. This enables the home to meet their needs. They can also be assured that this includes having regular health checks. The safe and secure handling and administration of medication for service users was generally found to be satisfactory. The exception was with the checking in of medication to ensure that any queries are identified and rectified with the pharmacist before the start of the new medication period. This will ensure all the medication is available to service users at the correct time. Service users can also trust that they will be treated with respect and their privacy will be protected, ensuring that their dignity and wellbeing is maintained. EVIDENCE: Four care plans were sampled. They contained full details of assessment, risk management, goals and actions required. They are regularly reviewed by keyworkers. A new care plan format has been introduced for new service users. In the file of a recent admission examined, only certain sections were Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 10 completed. The care manager indicated that the care plan format will be further reviewed, simplified and finalised by the end of the year and was having some “teething problems”. Staff were able to explain how they used the keyworker system to support service users. There is a record in each service user’s file, detailing appointments with G.P.s, chiropodists, and other visiting health professionals. At the time of the inspection there were no service users with pressure sores. Pressure care prevention equipment such as special mattresses and chair pads are used for those service users considered at risk. There was documented evidence on file that a patient with MRSA was being well managed by district nurses and staff. The home medicines policy is complete and all the documentation is in place and generally completed well. Three residents are self administering their own medication. There is a lockable space in their rooms for them to store the medication. The medication is stored in a clinic room but the temperature of this room rises above 25oC in hot weather. There are two trolleys which are clean and tidy and fastened to the wall of the clinic room when not in use. The room also houses the refrigerator for the storage of medication, a metal cupboard with a Controlled Drug section and a wooden inbuilt cupboard where any medication stock is kept. The refrigerator temperature is monitored and recorded and is maintained between 2-8oC. No Controlled Drugs were being kept at the time of the visit and there was no Controlled Drug register. Medication training has taken place and certificates were available. Most of the staff were trained more than a year ago. A new set of medication had been delivered by Boots for administration to the service users on the day of the inspection. The staff had identified some problems with the medication when checking it into the home. As Boots only work from Monday to Friday dispensing repeat monitored dosage medication for homes, they had been unable to contact Boots before the medication round on Monday morning. Two service users had been given dispersible aspirin instead of enteric coated aspirin. As a result of the above evidence three requirements were made. Service users reported that staff treated them respectfully and upheld their privacy. They said that personal care was provided in privacy and appropriately. All rooms, except two doubles, are single. These double rooms are reserved for the use of the two married couples in the home. Staff were observed acting respectfully with service users. There is a private telephone call box in the foyer for service users and relatives to use. Staff training includes a day on ‘The Jewish Way of Life’ , to ensure they are taught to understand and respect the cultural practices and beliefs of the service users. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Service users’ can be assured that the home makes excellent provision for activities and close contact with community and family, and provides a healthy and interesting diet. This enables service users to experience a lifestyle in line with their expectations and needs. Strong processes of service user and relative consultation reinforce the ability of the home to incorporate service users’ wishes into the all aspects of life and care at Rubens House. EVIDENCE: There was ample evidence of a comprehensive activities programme. Service users have input into the content and structure of the programme. On the day of the inspection, groups of service users participated in a quiz, newspaper discussion, drama therapy, large print floor games for people with dementia and an exercise class. Regular outings are undertaken and an in-house programme includes speakers on Jewish subjects, visits by entertainers, bingo and other games, art therapy, reminiscence and sewing classes. A team of volunteers helps run activities and are coordinated by an activities coordinator. The activities coordinator also plans, develops and undertakes individual activities with service users. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 12 The home has a dedicated synagogue which is used for regular Jewish celebrations and a Rabbi visits regularly. Activity timetables are posted on noticeboards throughout the home and individualised within service users’ files. All service users spoken to and surveyed indicated that they generally enjoy the activities and the choices offered. Hairdressing and manicures are also provided. Eighteen relatives returned their comment cards and indicated a high level of satisfaction with the home and their freedom to visit. Service users interviewed also indicated that they have regular family contact and service users’ rooms were decorated with family photographs and mementos. A volunteer advocate supports a service user without family involvement. Service users are supported to exercise control over their lives through regular residents meetings (minuted) and through informal consultation with staff. Relatives surveyed reported that they were extremely satisfied with how they and their resident family members were consulted and involved. Regular relatives meeting are held. Service users indicated that they are able to regulate their daily lives as they wished. The kosher kitchen is run and staffed by Eurest, an independent catering company. The prepared lunch was nutrious, healthy and culturally appropriate. During the inspection, the chef came around at the end of the meal and checked with all service users whether they liked the food and were satisfied with the quality. Service users indicated that this was a daily occurance and that their views and wishes were taken seriously. Regular food forums are also held. All staff and service users said that the food had definitely improved since Eurest took over. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Service users and their relatives can be confident that any concerns raised with the home will be effectively dealt with. Service users are protected by an appropriate adult protection policy and procedure that staff are familiar with. EVIDENCE: Only one minor complaint has been received since the last inspection. There is evidence that the complaints process is publically available and adhered to. Service users spoken to said they knew how to complain if they wished and would do so if necessary. Staff training files indicated that all staff have received recent adult protection training. Regulation 37 reports of serious incidents are sent to the CSCI. Individual staff members interviewed were familiar with the process of reporting suspected abuse. Service users reported that they felt safe in the home. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21 and 26 Services users benefit from a pleasant, clean and well resourced living environment that is generally well maintained. EVIDENCE: The home is extremely presentable and generally very well maintained. Only three minor maintenance issues were identified – a wall tile was missing in an upstairs bathroom, a floor/wall covering had come loose in another bathroom and a skirting board needs repairing in the dementia unit dining room. Requirements are made about these. The bedrooms are particularly well furnished, and highly personalised by each individualised service user. All storage furniture is lockable. There are an adequate number of bathrooms and toilet facilities for the service users. These are all appropriately equipped to meet the service users’ needs and the equipment is regularly serviced. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 15 The home was clean, hygienic and free from unpleasant odours on the day of the inspection. Cleaning staff were observed ensured a high standard of cleanliness on all floors. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 While the home has a well trained and generally stable staff team, in sufficient numbers, to support service users and to assist in meeting their assessed needs, there has been some instability in night staffing, which the home has followed sound procedures to cover. Service users are well protected by the home’s robust recruitment procedure. EVIDENCE: There has been disruption to night staffing after routine monitoring of night staff disclosed inappropriate practice. This resulted in the dismissal of some staff and the transfer of others. Service users were not affected. However, the CSCI was not informed of these issues at the time, which should have happened. This is a required in the future. In the interim period, while new staff are being recruited, a team leader has been moved over from the second night team and cover is provided by a mix of bank and agency staff. A requirement is given that night staffing arrangements and duties be reviewed to ensure that the service users are well supported at nights. Staff on duty during the inspection said that that staff meetings were regular and useful and that the home was sufficiently staffed. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 17 Four new staff files were sampled and contained copies of all the documents required in the standard. CRB disclosures are held in a separate locked filing cabinet and were obtained for all staff prior to employment. Staff training records seen and staff interviewed indicated that all new staff had a formal and systematic induction. The Jewish Care staff training programme is generally comprehensive and rolling programme ensures that gaps in training are addressed. Staff said the range and nature of training provided was relevant to their work. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 Service users can be confident that they will be regularly consulted for their views, to ensure that their best interests are preserved. The home has clear health and safety policies and procedures in place to protect service users and visitors. EVIDENCE: The home has an inclusive and wide ranging quality assurance process and according to designated quality staff, has progressed very well. A small group of staff from all areas of the home act as the designated quality assurance team, distributes questionnaires and gathers feedback from staff, relatives and service users. This feedback is fed up to the Jewish Care Quality Assurance Manager who then analyses it and produces a report for the home. An action Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 19 plan is developed and survey respondents (most chose not to be anonymous) are reported to on any action taken. Safe working practices are in place throughout the home and these are reinforced by regular staff training and meetings, monthly health and safety inspections and legislative compliance. Water temperature was checked in first floor bedrooms and bathrooms and found to be too hot. All sinks are fitted with temperature controls so the problem must be addressed immediately. A new push bar door closure has been fitted to a fire door in the kitchen and bolts removed from the other door. A fire safety inspection by LFEPA was carried out in June 2005 and the fire inspector recommended that the correct operations of all fire doors be recorded when the fire alarm is tested and that the emergency evacuation be fined tuned as required. New seals have been fitted on fire doors and checked. These required work to ensure correct closure and this work was being done on the day of the inspection. As required at the previous inspection, the home must comply with the fire inspector’s recommendations. A recent unit monthly health and safety review indicated that fire call points had not been tested when the maintenance person was on holiday. It is a requirement that appropriate arrangements be made to ensure all fire testing is done systematically. Fire drills occur monthly and are recorded in detail. Fire safety awareness training is regularly undertaken. Gas, electrical, water and equipment certificates were checked and were in order. The home has annual food safety checks and has been checked for legionella and cleared. A new emergency call system was installed in May 2005 and is working well. Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 2 Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 27(1) Requirement The Registered Person must ensure that night staffing arrangements and duties are reviewed to ensure the safety of all service users The Registed Person must ensure that the surfaces and walls of the upstairs bathrooms are repaired, sealed and properly maintained to ensure impermeability The Registered Person must ensure that the damaged skirting board in the dementia unit dining room is repaired The Registered Person must ensure that the water temperature in service user bedrooms and bathrooms is regulated correctly to no more than 43 degrees The Registered Person must ensure that all medication is checked correctly into the home and any errors reported to the pharmacist by the last working day before the start of the cycle. The Registered Person must ensure that the temperature of the room where medication is stored is maintained at 25C or Timescale for action 01 October 2005 2. OP19 13(4) 01 October 2005 3. OP19 13(4) 01 October 2005 01 September 2005 4. OP38 13(4) 5. OP9 13 01 September 2005 6. OP9 13 01 September 2005 Page 22 Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 below. 7. OP9 13 The Registered Person must ensure that the medication training is updated yearly for all staff who are authorised to administer medication. The Registered Person must ensure that the CSCI is informed immediately of any staffing matters of concern and of investigations into the concerns. 01 October 2005 8. OP27 37(1e) 01 September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rubens House v240414 g59 s10524 rubens house v240414 01.08.05 stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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