Care Home: Rubens House

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What the care home does well The preadmission assessments are good which means that only people whose needs can be met are admitted. The home encourages new residents to come and see the facilities before moving in. Care plans are completed and reviewed for all the residents. The care plans are comprehensive and identify the people`s individual physical, emotional, spiritual, social and health needs. The medication administration systems are well organised and people`s needs are met. Risk assessments are completed for those people who wish to take their own medication to ensure that they are safe. The social and leisure activities organised by the home show the effort the home makes to make life enjoyable, purposeful and interesting for people who use the service. People who live at the home are satisfied with the meals, the staff and the facilities of the home. The home has a well-organised, experienced and committed management system. What has improved since the last inspection? At the last inspection the manager was asked to regulate water temperature on the first floor and to change curtains in a resident`s bedroom. These two tasks have been done. The water temperatures are now checked and recorded weekly. What the care home could do better: There is a need in the dementia unit to place the television in a convenient position for all the residents to watch the programmes. CARE HOMES FOR OLDER PEOPLE Rubens House 184 Ballards Lane Finchley London N3 2NB Lead Inspector Mr Teferi Degeneh Key Unannounced Inspection 10:00 25 and 30th January 2008 th 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.V356017.R01.S.doc Version 5.2 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.V356017.R01.S.doc Version 5.2 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.V356017.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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 1960s. 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 managers office. Service users bedrooms are located on the first, second and third floors. There are two double bedrooms, one of which has ensuite 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. The fees for the home are £652 per week. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a surprise inspection, as the home had not been told that it was going to take place. The inspection was carried out over two days and involved observations of care staff while they were supporting people in the lounge and in the dining area. A number of people who use the service were also spoken to individually and in groups. The care staff, the chef, domestic staff, a visitor and the manager were also interviewed separately. Six residents’ files, six staff files and the other records of the home such as the health and safety records, incident and accident books, a complaints book and the home’s policies and procedures were seen. The menu, staff rota and the maintenance certificates were examined. The premises and facilities were visually checked during the tour of the building with the manager. The people who use the service said that they are happy and satisfied with their lives at the home. A resident said: “Everybody here is helpful, … everybody is so kind”. From observations it was evident that the residents are treated well and their needs are met by the services and facilities provided at the home. At the end of the inspection verbal feedback was given to the manager who stated that she would do her best to keep the standards of the service high and ensure that each residents’ needs are met. What the service does well: The preadmission assessments are good which means that only people whose needs can be met are admitted. The home encourages new residents to come and see the facilities before moving in. Care plans are completed and reviewed for all the residents. The care plans are comprehensive and identify the people’s individual physical, emotional, spiritual, social and health needs. The medication administration systems are well organised and people’s needs are met. Risk assessments are completed for those people who wish to take their own medication to ensure that they are safe. The social and leisure activities organised by the home show the effort the home makes to make life enjoyable, purposeful and interesting for people who use the service. People who live at the home are satisfied with the meals, the staff and the facilities of the home. The home has a well-organised, experienced and committed management system. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 6 What has improved since the last 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. The summary of this inspection report can be made available in other formats on request. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 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.V356017.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents are confident that their admission to the home is based on the result of their needs’ assessment and the suitability of the home to for their needs. EVIDENCE: A look at six files of the people who use the service confirmed that the home completes needs assessment for the residents before admission. The home’s annual quality assurance assessment (AQAA), which was sent to the Commission for Care Inspection, states that references for new residents are taken from their general practitioners or other professionals and considered by the home’s admission panel. It was stated in the AQAA that new residents are encouraged to visit the home and stay overnight to have the feel of the home for themselves. A carer who was visiting the home during the inspection confirmed that they have visited the home and participated in the needs assessment of the person who uses the services. The assessments which were seen in the files are detailed and there is evidence to show that the people who Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 9 use the service are involved. A number of people who were spoken to said that they are happy living at the home and that their needs are met. It was noted from discussions with a resident and the manager that the home was completing a new assessment for a person whose needs have changed since moving to the home. Jewish Care, the company that owns the home, has a social worker who works closely with carers, people who use the service and the other professionals to reassess peoples’ needs, where there are significant changes, and assist them move to accommodation that better meets their needs. There is no intermediate care at the home. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service have benefited from the home’s robust systems of care planning and risk assessment. The arrangements for the storage, administration and recording of medication are good and the people who use the service feel safe. EVIDENCE: All the six residents’ files which were assessed contained up-to-date care plans. It was clear from the files, discussions with the people who use the service and the home’s AQAA that carers and residents are involved in the review of care plans. Records of significant events are also kept in each resident’s file. Discussions with the manager and an assessment of the files showed that risk assessments are completed for all the residents. Observations indicated that people who use the service were relaxed and comfortable with many of them participating in various social activities provided by the care staff. Some residents were seen sitting and relaxing in communal areas including the reception. It was evident from observations that the residents have appropriate equipment provided for them as part of their risk Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 11 assessment. All the communal areas are bright and there are appropriate adaptations such as hand grab rails in the corridors, call alarm bells in bedrooms and toilets. A team leader, who has attended training in medication, administers medication. Medicines are stored in a room known as the surgery room. All medicines are kept in a locked cabinet in the room. The medicines and the medication administration record sheets were checked and were in order. The home has a system for monitoring and recording the temperature of the room where the medicines are kept. The records showed that the temperature has been kept at a 22º Celsius and the team leader confirmed that it has never been above 25º Celsius even during the summer. There are some people who take their own medication. Risk assessment has been completed for these people to confirm that they are able to look after and take their medication. The manager and general practitioners have signed to approve the people’s ability and wish to take their own medication. The residents have also signed to say that they can take their medication. From discussions with the residents and the care staff it was evident that the people who use the service regularly see health professionals including an optician, a dentist and a chiropodist. Records and discussions also showed the home arranges for the people to attend hospital appointments. A doctor comes every week to the home to check the health needs of the people. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of the meals provided at the home is high and the peoples’ individual needs are met. There are stimulating activities for the residents and the people who live here are engaged. EVIDENCE: Discussions with a number of the residents and observations showed that the residents are engaged with activities that meet their needs. Two of the residents spoken to explained how they are engaged everyday with activities which include arts, bingos, watching films, games, reminiscence classes, trips to shops and shows and reading newspapers. The home has a fulltime member of staff with the responsibility to organise and provide activities for the residents. The care staff were observed keeping the residents engaged with games which the residents appeared to enjoy. The staff were also seen interacting appropriately with the residents. Many residents said in conversations that the staff are good and it is a good sign when the turnover of staff is low at the home. The home has a key working system which has enabled it to identify and provide a suitable support for each resident. During a two-hour observation of staff interaction in one of the rooms it was noted that the staff addressed the residents in ways that the residents seemed to like. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 13 It was clear from discussions with the residents that there are no time restrictions for going to bed or getting up. From observations and conversations with the residents and the staff it was evident hat the staff respect privacy, dignity and choice of the resident. The residents spoken to confirmed that the staff always knock on the doors and wait for permission before entering bedrooms. One resident explained how their family kept contact with them by visiting weekly and ringing them every evening. The person said they have their own telephone line in their bedroom. The manager said that all the residents are registered to vote on the electoral roll. The home has a four weekly rotating menu which offers at least two options for the main meal. The head chef stated that every morning the residents are asked what they want from the two options. Provision is made for people who have special dietary need. It was clear from discussions with the head chef and some of the residents that the home provides meals outside the menu if that is what the residents wanted. At the lunchtime the staff were seen providing appropriate assistance to those people who needed help with their meals. Many people who were spoken to said they are satisfied with the variety and amount of meals provided at the home. The home has a head chef and two other chefs who prepare the meals. There are also kitchen assistants. The kitchen area was seen to be clean and all the food items in the fridge freezers were labelled with the opened or use by dates. An environmental health officer rated the cleanliness’s of the kitchen area as a 5 star. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that their concerns can be listened to and acted upon by the home. EVIDENCE: The home has policies and procedures on complaints and safeguarding adults. Six care staff who were spoken to were able to give a satisfactory description of what adult abuse means and the actions needed to ensure that people are safeguarded from abuse. The home has kept records of complaints, incidents and allegations and has notified the Commission for Social Care Inspection about the occurrence of significant events such as the falls of residents or the admission to the hospital of some people. A visitor spoken to said they know how or who to complain. A number of people spoken to also said they are clear who to speak to if they have concerns. Observation on showed that the residents can talk to the assistant manage or the manager if they have a concern. The manager said she has an open door policy and staff and residents can talk to her if they have concerns. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is spacious, clean and has equipment and facilities that meet the needs of the people who stay there. EVIDENCE: All the communal areas were clean, bright and free from bad smells. The corridors are wide and are fitted with hand grab rails. Sofas and chairs have been provided in the reception area, which meant that some people choose to sit, relax, socialise and have drinks there. It was observed in one of the lounges that the television set was not positioned conveniently for some people to watch it. This was discussed with the manager during a feedback session and she said she would look into placing the television in a position where it is convenient for all to see. The people who use the service said they are happy with the home and with their bedrooms. The manager was asked to regulate the water temperature on the first floor and to change curtains in a resident’s bedroom. Both these have been done. The home is located close to the shops and public transport facilities. There is a well looked after garden at the back Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 16 and car park spaces at the front of the building. The back garden, the front of the building and the rooms are accessible. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home have benefited from care staff who are trained, experienced, committed and properly vetted by the home’s recruitment procedures. EVIDENCE: The staff have been observed for two hours in one of the dementia units where they were supporting the residents. It was evident from this observation that the people who use the service are treated with respect and dignity. The staff interaction with the residents was in such a way that it promotes the residents’ confidence and gives them choice. There were sufficient number of staff at the lunchtime to assist people with meals. Four care workers work in the unit for dementia while five care staff support people who are more independent. There are also a team leader, an assistant manager, a social co-ordinator and the manager on shift. There are adequate number of staff responsible for cleaning, laundry, cooking and maintaining the facilities of the home. Discussions with the manager showed that volunteers are also used by the home. The six care staff interviewed demonstrated their good knowledge and experience of supporting older people and people with dementia. A number of the residents spoke positively about the staff. For example, a resident said: “everybody here is helpful; nothing to grumble; everyone is so kind”. Another resident also stated: “They [the staff] are very good to us [residents]; we are Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 18 lucky to be here; the carers are helpful to us”. A relative who was visiting the home said they are satisfied with the care provided at the home. The home has a recruitment procedure and the staff files, which were seen, contained written references, employment contracts and satisfactory criminal record checks. The care staff spoken to said there is a good teamwork at the home. It was evident from discussions with the staff and the files that the staff have attended training in various areas including, fire safety, manual handling, health and safety, dementia and safeguarding adults. The home’s annual quality assurance assessment states that out of a total of 33 care staff, 11 have a national vocational qualification level 2 or above while 11 others are currently working toward achieving the same qualification. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and safety, and wellbeing of the people who use the service are ensured by the home’s policies, procedures and good management system. EVIDENCE: The manager has been in post for the last seven years and is assisted by the assistant manager, team leaders, a social activities co-ordinator and a service manager. The management of the home have worked hard to keep the standard of care provided high to make life comfortable for the people who use the service. It was evident from discussions with the staff, a visitor and the residents that the staff work as a team by supporting each other. The manager has an open door policy which has enabled people to talk to her or the other Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 20 management team if they have concerns. The manager has previously worked in a similar care home for a number of years. The manager appeared to be an open person with a commitment to improve the service and to ensure people’s rights to live in a safe and comfortable home. The home has a system for listening to the people who use the service, their carers and relevant people to improve the service. In the AQAA (a document sent by the manager to the Commission as part of this inspection), the registered person explained how they consult with the people who use the service and their relatives by organising quarterly meetings and by including their suggestions in the work plans. This was confirmed during the inspection. It was also noted that the home undertakes a monthly audit of medicines and an annual financial audit. The home does not manage the residents’ finances. However, personal allowances of some residents are given to the home either by the residents or their relatives for some ongoing expenses such as toiletries, hairdressers and newspapers. This money and the records are kept in the office. A quick look at some samples of the records on the computer showed that all transactions of expenses, receipts and balances are recorded appropriately. As mentioned under National Minimum Standards 19 and 26 above, the home was clean, bright, spacious and free from bad smells. There is a safe working practice throughout the home. From the AQAA and discussions with the manager it was evident that monthly health and safety checks take place. Incidents and accidents are appropriately recorded and actions are taken to deal with the incidents. A fulltime member of staff has been employed to check the equipment and take action to maintain either by themselves or by reporting to the manager. The health and safety and fire records are well maintained. Records showed that fire alarms and the water temperature are tested weekly. The emergency lights are checked monthly and fire drills are carried out quarterly. It was clear from the records that the fire extinguishers, fire detectors, the lifts, and the gas boilers have all been checked and serviced. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 21 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 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 OP19 Good Practice Recommendations The registered person should ensure that the television set in the unit for dementia is placed in a convenient position where all the residents can watch the programmes. Rubens House DS0000010524.V356017.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V356017.R01.S.doc Version 5.2 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. 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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