Inspection on 06/02/06 for Rubens House

This inspection was carried out on 6th February 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rubens House 06/11/06

Rubens House 01/08/05

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 Inspection 6th February 2006 10:00 X10015.doc Version 1.40 Page 1 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 Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 Page 2 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 DS0000010524.V271058.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rubens House Address 184 Ballards Lane Finchley London N3 2NB Telephone number Fax number Email address Provider Web 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 Jewish Care Mrs Kok Ying Idelbi Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Old age, registration, with number not falling within any other category (51) of places Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 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 DS0000010524.V271058.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. It was undertaken by Inspector Margaret Flaws, as part of the routine schedule of inspections for the home. The Registered Manager, the Care Manager and ten staff of Rubens House were spoken to on the day of the inspection. The inspector spoke to seven service users and two others with whom communication was difficult due to dementia. Two relatives visited during the inspection and spoke to the inspector. The inspector also spoke to a group of staff and four other staff individually, as well as the Registered Manager, Care Manager, Team Leader, Activities Coordinator and Maintenance Person, who all assisted throughout the inspection. A extensive 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. Two new requirements were made on this inspection and one was restated from the last inspection. What the service does well: What has improved since the last inspection? At the last inspection, eight new requirements were made. Seven have been met. Repairs to surfaces in two bathrooms and the dining room have been done. Three medication requirements are made. An additional checking process has been put into place to prevent medication errors. An air conditioning unit has been installed in the medication room. All staff have now received medication training. A review of night staffing arrangements has been done and the manager is aware of responsibilities to inform the CSCI of any matters of concern. Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 Page 6 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 DS0000010524.V271058.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 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 the following standard(s): 3 Service users can be satisfied that the home has a formal process of assessment and trial visits are available for them to determine mutual suitability and the appropriate level of care required. EVIDENCE: Four care plans were sampled on this inspection. They were all new admissions to the home since the last inspection. They all contained comprehensive assessments. All referrals are initially 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. There were no vacancies on the day of the inspection. One person was in hospital. The home does not provide intermediate care. Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 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 the following standard(s): 7,8, 9 and 10 Service users can be assured that their care is well provisioned, planned and reviewed. They can also be assured that they will have regular health checks. Medication is safely and securely handled and administered. 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. Their cultural rights are respected and honoured in the home. EVIDENCE: Four service user care plans were sampled. All contained full details of assessment, risk management, goals and actions required. They were regularly reviewed by keyworkers. Good processes of review are in place. The manager and the care manager discussed in detail how the home is managing the complex needs of two service users, one of whom is being considered for transfer to another home. There is a record in each service user’s file, detailing appointments with G.P.s, chiropodists, and other visiting health professionals. There is good provision for the needs of service users who have hearing or sight impairment and ways of meeting their needs and communicating with them are well understood by Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 Page 10 staff. There are also good life histories for service users on file, which provides a helpful holistic summary of their lives. At the time of the inspection one service user had a pressure sore. The local district nurses visit regularly to change dressings and the Tissue Viability Nurse is regularly consulted. These visits are documented and the notes kept in the clinical treatment room. Pressure care equipment such as special mattresses and chair pads are used in the home for prevention and healing. The home has an appropriate medication policy and procedure, which was inspected by the Pharmacy Inspector last August 2005. Three related requirements have been met. An airconditioning unit has been installed in the clinical treatment room, where medications are stored. Temperatures are recorded. These were checked and none were recorded as over 25degrees since the last inspection. MAR sheets were sampled and there were no errors identified. The Team Leader said that the doctor, who visits weekly, has recently done a medication review and this has resulted in a reduction in the number of medidcation service users need to take and has been beneficial. Medication returns were checked and were in order. Most staff have now received annual medication training or are booked for it. The Team Leader described a new system of checking that has been put in place to prevent problems with repeat prescriptions for service users whose medications run out over the weekend. The inspector was able to speak to several service users and also spent considerable time sitting in the dementia unit lounge observing interactions between staff and service users. These interactions were sensitively handled. Staff demonstrated familiarity with the service users and treated them with respect and dignity. Service users confirmed this when interviewed. They also said that staff upheld their privacy. There is a private telephone call box in the foyer for service users and relatives to use. Staff training includes a day and regular updates 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 DS0000010524.V271058.R01.S.doc Version 5.0 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 the following 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 constant input into the content and structure of the programme. On the day of the inspection, groups of service users went on outings and in the afternoon, there was a major satirical theatre performance, with staff and service users participating along with the actors. The service users said that they really enjoyed it and that the home had regular in-house drama performances, discussion groups and speakers and entertainers coming from outside. There are also programmes of arts and crafts, reminiscence, music, games, as well as individual activities programmes and outings. The home offers hairdressing, beauty therapy and exercise classes, as well as activities tailored for the needs of people with dementia. The activities coordinator has developed her new position well, and is supported by staff, who often lead activities sessions and by a team of volunteers. The home has a synagogue which is used for Jewish celebrations and a Rabbi visits regularly. Activity timetables are posted on noticeboards throughout the Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 Page 12 home and documented in service users’ files. All service users spoken to said that they enjoy the activities and the choices offered. Service users and relatives described regular contact and said that the home’s procedures supported unlimited visiting. The kosher kitchen is run and staffed by Eurest, an independent catering company. The prepared lunch was nutritious, healthy and culturally appropriate. Service users were positive about the food in the home. Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 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 the following 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 and trained to use. EVIDENCE: Two complaints have been received since the last inspection and these were appropriately investigated and dealt with. The complaints process is publicly available and service users spoken to said they knew how to complain if they wished. Staff training files indicated that all staff have received recent adult protection training. Service users reported that they felt safe in the home. Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22, 23, 24 and 26 Services users benefit from a pleasant, clean and well resourced living environment that is generally well maintained. EVIDENCE: The inspector toured the home with the maintenance person and the clinical areas with the Team Leader. The home is extremely presentable and comfortable. The communal areas are homely and pleasantly decorated. The communal areas are well used as part of the activities programme. The dining room is the largest space available and was used for a play on the day of he inspection. There is a garden to the rear of the building. The bedrooms are particularly well furnished, and highly personalised by each service user. All storage furniture is lockable. All rooms, except two doubles, are single. These double rooms are reserved for the use of the two married couples in the home. 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 Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 Page 15 and the equipment is regularly serviced. There are assisted bathrooms and five hoists available throughout the home and staff are trained in their use. The home was clean, hygienic and free from unpleasant odours on the day of the inspection. Cleaning staff were observed ensuring a high standard of cleanliness on all floors. There is one cleaner dedicated to each floor and there is a cleaning register in each bedroom, so that the service users know when their room has been cleaned (normally daily). Minor maintenance issues identified on the last inspection have been rectified– missing tiles and floor/wall coverings replaced in upstairs bathrooms and a skirting board repaired in the dementia unit dining room. A requirement is made to repair the tiling and vinyl flooring in another upstairs bathroom. Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The service users can feel confident that the staffing levels have been reviewed and are sufficient to meet their needs. Service users are well protected by the home’s robust recruitment procedure and good staff training and support. EVIDENCE: The Care Manager is currently covering the Administrator’s duties, which has added to his workload at this time. The home also has a vacancy for one Team Leader. Another long standing Team Leader has won a national award as Carer of the Year 2006. The Registered Manager and the Care Manager discussed how night staffing has been reviewed after a period of disruption. Staff who had been dismissed, have been reinstated. Sound checks and balances are in place to protect the service users, who were not affected by the prior disruption. The management team are aware of their responsibilities to inform to CSCI of any changes in staffing or concerns that may occur. The Manager said that Jewish Care has recently undertaken a staffing audit to check the legality to work of its entire staff. Some discrepancies were identified and two staff left the home as a result. Staff interviewed said that they were happy with the staffing arrangements and that they were well resourced to do their jobs. All receive supervision every eight weeks, which is documented in supervision records. Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 Page 17 Three new staff files were sampled and contained copies of all the documents required under Schedule Two of the NMS, but one person did not have a photograph on file, which is required. CRB disclosures are held in a separate locked filing cabinet and were obtained for all staff prior to employment. Staff receive a systematic and comprehensive induction. The induction includes First Aid, Manual Handling, Health and Safety, Adult Protection, Dementia care, and literacy. Training records were examined. There is an ongoing programme of dementia awareness, run over eight weeks, as well as other statutory and care related training, which all staff attend. Most staff have NVQ2 or NVQ3, or are in the final stages of one of these programmes. Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 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: 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 good legislative compliance. Incident and accident records were inspected. They identified the loss of small amounts of money from service users bedrooms. An appropriate process of investigation and follow up was undertaken. Service users all have a lockable facility in their rooms and risk assessments have been done for the handling of service users’ money and valuables. Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 Page 19 Water temperature was checked. In some first floor bedrooms and bathrooms it is still too hot. The Maintenance Manager said that this was because one of the boilers has an old mixer that needs replacing. This should have been done after the last inspection identified this problem. The related requirement is restated, as this is a clear health and safety issue that needs addressing. There are now appropriate arrangements in place to ensure all fire testing is done systematically, including when the Maintenance Manager is on holiday. Fire drills occur monthly and are recorded in detail. Fire safety awareness training is regularly undertaken. Fire equipment had an annual check in October 2005. Gas, electrical, water and equipment certificates were checked and were in order. The hoists and assisted baths were last checked and found to be in order in January 2006. Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP19 Regulation 13 (4) Requirement The Registered Person must ensure that the tiling and flooring of a second floor bathroom is repaired or replaced. The Registered Person must ensure that all staff files, including those of new staff, contain a recent photograph for each staff member. The Registered Person must ensure that Timescale for action 15/04/06 2. OP29 19 (4); Sch. 2 15/04/06 3. OP38 13 (4) 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rubens House DS0000010524.V271058.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Southgate Area Office 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 DS0000010524.V271058.R01.S.doc Version 5.0 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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