The comprehensive inspection of this service took place on 4 and 5 January 2018. It was unannounced. At our last focussed inspection of this service we found it to be Requires Improvement in the key areas of Safe, Effective and Well Led, however there were no legal breaches of regulation at that time. Other key areas of Caring and Responsive were found to be Good.

Andrew Cohen House is a care home with nursing and can accommodate up to 59 people in one adapted building. The home specialises in providing care to people living with dementia in small separate units within the building. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

People were protected from potential abuse by staff that were trained and understood how to safeguard them. People had risks to their safety assessed and there were plans in place to reduce the risks, which staff understood and followed. There were sufficient staff that had been recruited safely to support people when they needed it. People received support to have their medicines as prescribed. There were systems in place to learn from incidents, or when things went wrong to avoid this happening again.

People had their needs assessed and were supported to meet them by trained well-supported staff. People had their nutrition and hydration needs met and had enjoyable mealtime experiences with lots of choice. The building was purpose built and designed to meet people's needs. People were supported to access health professionals to maintain their health and wellbeing. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and the policies and systems in the service supported this practice.

People had good relationships with staff and were supported in a kind, caring and compassionate manner. People made choices about their care and support and were involved in decision making. People were supported in a way, which maintained their dignity, and staff were respectful.

People had their preferences met and staff understood people's needs.

There were opportunities for people to follow their interests and take part in a wide range of activities. People's communication needs were considered and they had support to follow their religious beliefs and cultural practices. People understood how to complain and complaints were responded to in line with the provider's policy. People had the opportunity to take part in discussions about their preferences for care and support at the end of their life.

A registered manager was in post and people, relatives and staff found they were accessible. People and their relatives had an opportunity to have say in how the home was run. The registered manager had checks in place to assess the quality of the service people received and ensure the management of the service was effective. The registered manager had a vision for the service and plans in place to make continual improvements.

Andrew Cohen House is a care home which provides nursing care to older people and people living with dementia. The home is registered with the Care Quality Commission to offer accommodation for up to 59 people. On the day of our unannounced inspection there were 57 people living at the home.

We carried out an unannounced comprehensive inspection of this service in November 2016 and breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to failures to manage risks to health and safety of people arising from the poor management of prescribed skin creams and the lack of an effective auditing system to assess, monitor and improve the service to keep people safe and well.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. Since our last inspection concerns about people’s safety had been raised with us and we used this information to inform our planning. This report only covers our findings in relation to requirements and the information we have received. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Andrew Cohen House on our website at www.cqc.org.uk

At this focussed inspection we found that improvements had been made in the two key areas of Safe and Well Led and the home were no longer in breach of the regulations. However further improvements were still required.

The manager was at the service during the inspection and has applied to become the registered manager with the Care Quality Commission. 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 told us their care was safe and that there were enough members of staff on duty to support them well. We saw that staff moved people safely and met their needs in a timely manner. At this inspection we found that people had care plans and records of their changing needs that were person centred and up to date. These improvements helped to ensure people were kept safe.

People’s risks had been reviewed and actions had been taken as required to ensure people remained safe and well. During this inspection people and staff told us that people received their medication as prescribed but we saw that recording of when skin creams had been administered was not robust.

The inspection took place on 19, 20 September and 20, 21 October 2016. The inspection was unannounced. Andrew Cohen House is a residential home which provides nursing care to older people most of whom are living with dementia. The home primarily serves the Jewish community, and welcomes people of other faiths who chose to live there. The service is registered with the Care Quality Commission to provide accommodation and personal care with nursing for up to 59 people, and at the time of our inspection there were 53 people living at the home.

The new manager came into post on June 2016, shortly after the previous registered manager had left. Before this inspection had completed , the manager became registered with the Care Quality Commission. A 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 and associated Regulations about how the service is run.

At our previous inspection on 7 and 8 April 2016 we asked the provider to take action in relation to two areas. The provider met with us to discuss these areas and submitted an action plan and monthly updates telling us of their progress. The first area was to make improvements to the respect and dignity staff showed towards people. This action has been completed. The second required action was to improve the systems and processes to make sure the service provided was monitored and audited to improve the quality of life for people living within the home. This action has been progressed but had not been fully completed.

Since the inspection of April 2016 we received concerns in respect of the care and support provided to people, the competency and attitude of staff and concerns about the management of medication. We considered the information we had received and used it to inform our inspection plans.

People and their relatives told us that they felt safe with the staff who supported them. Staff were aware of the need to keep people safe and understood their responsibilities to report allegations or suspicions of any poor practice. Assessments had been undertaken to identify any potential risks to people, but records of these were not all up to date or accessed and used by staff to manage the risks. Moving and handling transfers were carried out in a safe manner.

People were supported by suitable staff who had been properly recruited.

People who needed support with medication could be assured that medicines were being given as prescribed and were stored safely; although improvements were needed in respect of management of peoples prescribed creams.

People were being supported by staff who had been provided with training to keep their knowledge and skills current. Staff told us that they had received a planned induction when they commenced working at the home. Staff’s knowledge and understanding of The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been supported by training, but some staff were not sure how it applied to protect the rights of people living in the home.

People were provided with choices of food and drink and were supported to access relevant healthcare professionals when needed. Staff demonstrated that they knew people well and we saw that people were supported in a kind and caring manner.

We saw that people were cared for by staff who knew them well and who they described as kind and compassionate. People expressed how they wanted their care to be delivered, but this was not well recorded. People’s decisions and choices were respected by staff. People told us, and we saw that they were treated with dignity and had their privacy respected.

People were supported to participate in many social activities of their choice. Improvements in the home had enhanced the daily lives on some of the people in the home with the provision o

This inspection took place on 7 and 8 April 2016 and was unannounced. At the time of our visit 48 people were living at the home.

There was no registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A manager had been appointed and was managing the home, but they were in the process of becoming formally registered as the manager of the home.

Staff knew how to recognise potential signs of abuse and how to raise concerns should they need to. Risks to people had been assessed and measures had been put in place to reduce the risk to each person. Staff had received training to enable them to provide safe care to meet the needs of the people they were supporting. Staff did not have adequate support or supervision to make sure that people’s needs were consistently well met or that the support people received was respectful and dignified. You can what action we told the provider to take at the back of the full version of the report.

Changes in people's needs were identified and their care packages were amended when necessary to meet these needs. The information contained in the care records was individualised and clearly identified people's needs and preferences. However staff did not consistently make sure that people’s needs were well met in the way that had been agreed. Risks people might experience with their care and environment had been identified and recorded in their care plans.

We saw that medicines were managed safely. Staff had access to information about the specific support people needed with their medicines and new systems were being introduced to monitor medication administration practice.

We saw that safe recruitment and induction processes were in place to ensure there were enough suitable staff employed to support the people who used the service.

The manager was knowledgeable of, and acted in line with, the requirements of the Mental Capacity Act (2005). Staff did not always seek peoples consent before supporting them.

There was a complaints procedure in place that was known about and used by people who used the service and their relatives. Where concerns were raised we saw that the manager had acted promptly and taken action.

People had a range of activities that they could choose to engage in every day. Staff had begun to use aids and equipment designed to enrich the lives of people living with dementia. Management had plans in place to expand on this work and offer a service that would improve the quality of people’s lives. There were systems in place for monitoring the quality and safety of the service, but these were not always effective. You can what action we told the provider to take at the back of the full version of the report.

A pharmacist inspector from the Care Quality Commission visited the home to look at medicine management. This was in order to follow up on a warning notice issued to the service following our previous inspection in July 2014.

We set out to answer one of our five questions, Is the service safe? Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

We found that some improvements had taken place but there were not appropriate arrangements in place to ensure staff managed the risks associated with the use and management of medicines. Shortly after the inspection we also met with the provider representative, provider area manager and the home manager to discuss the issues and action that had been taken. We were told of further improvement actions that had been taken between the inspection and the meeting as well as other actions that were planned.

When we visited 56 people were receiving care at the home. We spent time with people living at the home and observed how they were being supported. We spoke with nine people who lived at the home and with the relatives of four people. We also spoke to the registered manager and five members of the nursing and care staff.

Throughout the inspection, we found that staff treated people with respect and supported them in a friendly, engaging manner. People told us they were happy with the service they were receiving and how their needs were being met. One person told us, “I can’t think of anywhere better to be. The staff are all very nice.”

Care was planned and designed to meet the individual health and welfare needs of the people who used the service.

We found that people were not always protected from the risks associated with the unsafe use and management of medicines. . We found that internal audit processes had failed to identify that improvements were needed in respect of cold storage of some medicines and routine recordings of medication administration.

The provider had satisfactory recruitment procedures in place to ensure that people employed at the service were of good character and had the necessary skills to meet the needs of the people who used the service.

People told us they felt able to complain if they were not happy about their care, although the information provided to people using the service was incomplete.

We visited Andrew Cohen House and spoke with seven people who lived at the home about the care and support they received. People told us they were happy with the service they were receiving and how their needs were being met. One person told us, ‘’The service we get is excellent.’’

During our visit we spoke with relatives of three people who lived at the home. They told us they were satisfied with the care provided. One relative told us, ‘’I have nothing but praise for the home.’’

Throughout the inspection, we found that staff treated people with respect and supported them in a friendly, engaging manner. People living at the home confirmed their privacy was respected. Not all people spoken with could remember planning their care but we found evidence of consultation, wishes and preferences in records.

Staff told us that they were well trained and felt they had been provided with the appropriate support in order to do their job effectively.

People living at the home told us they felt safe and were able to raise any concerns they had.

There were systems in place to monitor the quality of the service. Complaints and comments from people were used to assess if they were happy with the service.

55 people were living in the home when we visited and we talked with five of them and their visitors about their experience of living there.

The people living in the home told us they were happy with the quality of the care and support they were receiving. They said:

“It’s not too bad really.”

“Staff look after me, they’re quite good really, pretty helpful.”

“Staff are very nice indeed, they will always help you.”

People and their relatives told us staff treated them with respect and helped them to be as independent as possible. We saw staff taking time to talk to people and socialise with them.

People and their relatives told us they were happy with the meals provided at the home. They said:

“Very nice, if you don’t like what’s on offer they will offer other things.”

People and their relatives told us the home had carried out an assessment before they had moved in, to make sure it would meet their needs.

We carried out a comprehensive inspection of this service on 10 February 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection on 20 and 27 May 2015 to check that they had followed their plan and to confirm that they now met legal requirements in relation to warning notices that we had previously issued. We found that the provider had responded to our warning notices and taken appropriate actions to meet the legal requirements we looked at.

This report only covers our findings in relation to the warning notices we issued in regards to the care and welfare of people and assessing and monitoring the quality of service provision. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Andrew Cohen House on our website at www.cqc.org.uk

Andrew Cohen House is registered to provide nursing care and support for up to 59 older people who have needs relating to old age, on-going health needs or people living with dementia. When we visited there were 42 people living at the home.

A registered manager was in post but they had not been working at the home for several months, it was not known if they would be returning. 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 and associated Regulations about how the service is run.

Staff were being supported by a team of external consultants who had been employed by the provider to help make improvements to the service. Two new deputy managers had also been recruited who were both currently acting as managers. We had been informed by the provider of the management arrangements in the absence of the registered manager. The majority of staff we spoke with commented that leadership and communication had improved since our last visit.

People told us they were supported to eat and drink sufficient amounts to maintain their health but we found systems to monitor that people were getting enough to drink needed improvement. Risks to people’s nutrition were minimised because staff understood the importance of offering appetising meals that were suitable for people’s individual dietary needs. People’s health was monitored and they had access to healthcare professionals when this was required.

The provider had made changes to their quality assurance and audit programme. This had included reviewing a range of audits such as medication, infection control, the environment and people’s mealtime experience. The records showed that when issues were identified, actions were planned or had been taken to improve the quality of the service. Some improvements were still needed to make sure that issues with the quality of record keeping were identified and acted on. Some issues identified by other health professionals in regards to medication procedures had yet to be resolved.