This inspection took place on 12 and 15 July and was unannounced. At our previous inspection in April 2015 we found breaches of regulations relating to the management of medicines and safe care and treatment. At this inspection, we found that the provider had made improvements and was now meeting these regulations.

Beis Pinchas is a care home with nursing, which is registered to provide accommodation to up to 44 people. At the time of our inspection the service was fully occupied. The service provides support to older men and women from the Orthodox Jewish community. Beis Pinchas is a four story, purpose built building with communal facilities including a day centre, dining room, sensory room and a newly built spa area. There was a large synagogue which is also used by the local community. It shares facilities with the supported living service next door, which jointly forms Schonfeld Square Care Home. All rooms have an ensuite shower, and each floor has shared bathrooms with lifting baths and hoists.

The service had a registered manager. 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.

The building was clean throughout, well decorated and well maintained, and provided a safe and accessible environment. Communal areas were large, bright and airy, and featured a computer room, an indoor sensory garden and a large dining area. A 24 hour security guard ensured people were safe.

Risks to people were appropriately assessed and plans were in place to manage these risks. Care plans for people had detailed information about their needs, wishes and life histories, and provided staff with enough information to deliver personalised care. The provider had recently introduced an electronic care notes system which ensured that important information was seen by and recorded by staff, and allowed long term trends in people’s health and needs to be observed. This system aided the delivery of co-ordinated care, for example by automatically generating information to be handed to hospital in the event of an admission. The same system was used to record people’s wishes about end of life care. Medicines were safely stored and administered by the nursing staff, who provided strong and confident leadership.

The provider took care to ensure that meals were of a high quality, nutritious and compliant with Jewish law. People who needed support from staff to eat received this with patience and dignity. Where people were at risk of malnutrition, staff assessed this and recorded people’s food and fluid intake and monitored people’s weights appropriately. Staffing levels were adequate to meet people’s needs, and the service also benefitted from a team of volunteers who provided additional support to people. There were robust and safer recruitment processes in place for staff, and processes in place to ensure that nursing staff were appropriately registered. We noted that the provider had difficulty retaining staff in some cases, which was a source of dissatisfaction to some people we spoke with.

There was a comprehensive and varied activities programme in place, this included visits out to places of interest and typically six activities a day in the communal areas of the building, including talks, exercise groups and music. These were well attended and very popular with people who used the service. Many of these activities were based around Jewish culture and beliefs, which was integral to the way the service was run, and showed strong links with the local community. Staff received frequent training and instruction on how to meet people’s cultural needs. People were dressed appropriately in their chosen clothes and their dignity and privacy were respected. Staff u

On the day of our inspection we spoke with nine people who use the service and eight relatives and friends. We also spoke with a volunteer, members of the nursing and care staff, the care manager and the chief executive. People using the service and their relatives all told us the care was good and the staff were caring. One person using the service said, "I get very good care and the staff are very co-operative. The building is clean and I feel fine here." A relative told us, "it is especially nice and safe here. The staff really pay attention to what people need and there are good social activities."

People told us staff understood their needs and provided appropriate care and support. We found that care was recorded appropriately, with potential risks to people's safety monitored, assessed and updated in a timely manner.

Beis Pinchas provided a comfortable, safe and well maintained environment.

People using the service, and their relatives, told us there were sufficient staff to meet people's holistic needs.

The home had effective systems in place for keeping records which helped to protect people's privacy and safety.

People using the service told us they felt happy and safe living at Beis Pinchas, and the staff were kind and supportive. We spoke with seven people using the service and with the relatives of two other people. A person living at Beis Pinchas told us, “I am very well looked after. I am given choices and the food is fantastic. I like to welcome and help new people.” A relative said, “We have nothing but good to say. The staff are very caring and friendly. They treat the residents as very important people.”

We saw staff supported people in a gentle and caring manner. People using the service were offered choices regarding their daily routines, activities and meals. One person told us, “I choose to get up early for prayers and the care workers know this. They arrive on the dot to help me. All of them are very kind and it is a wonderful place.” Another person said, “the food is good and tasty and the kitchen staff will always change it if there is a problem.”

We spoke with seven people working at Beis Pinchas, including the registered manager. Staff told us how they promoted people’s dignity, offered choices and helped people to feel safe. One member of staff told us, “we are given a good package of training and support. We are encouraged to always think about people’s rights to privacy and respect.”

There were systems in place to seek and act upon the views of people using the service, and monitor the quality of the service.

People we spoke to told us that they were very happy at Bees Pinchos. We received many complimentary remarks about the service, its facilities and the members of staff.

The inspection took place on 27, 28 and 29 April 2015 and was unannounced.

Beis Pinchas is a 44 bedded care home with nursing. It provides care and accommodation for people from the Orthodox Jewish community. There were 39 people living at the home at the time of our inspection.

A new manager had been in post since December 2014 and has a pending application to register as the registered manager of 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.

During our inspection we found many areas of good practice and also areas where improvements needed to be made, particularly around accurate records, risk assessments and care files. The manager was aware of most of these areas and the service was undergoing a programme of improvement.

Medicines were largely being administered safely and regularly. However we found improvements were needed for people prescribed pain relief on a when required basis, people having their medicines crushed before administration, and people on anticoagulant medicines. Staff were not always following best practice or the medicines procedure.

People were not always protected from risks to their health and wellbeing because assessments did not provide adequate guidance for staff.

Staff were inconsistent in their understanding of how to support people when they displayed behaviour which challenged the service or others. We found areas of good practice around supporting people with anxiety related to living with dementia but there were discrepancies between staff about whether lawful restraint was used, putting people at risk.

Up to date nursing registration numbers were not held in all staff files.

A thorough recruitment system meant people were supported by care staff and volunteers who were suitable for work in the caring profession.

People were safeguarded from abuse and ill treatment by staff who could recognise signs of potential abuse and know what to do when safeguarding concerns are identified.

Sufficient numbers of staff had been deployed throughout the service to meet peoples’ needs.

The control and prevention of infections was well managed.

Training was provided so that staff had the necessary skills to meet peoples’ need.

The provider had carried out mental capacity assessments and protected people who could not consent to a restriction on their liberty that was necessary for their safety. More information in care plans was needed to guide staff about what was in someone’s best interests.

People were supported to maintain a balanced and enjoyable diet, however, the provider could not be assured people had adequate nutritional intake because records were not up to date.

The provider supported people to maintain good health because they had good access to healthcare services for ongoing support.

The provider did not always support people adequately around their end of life care because care plans did not contain enough information. The provider had recently begun work with a local hospice to improve this area.

The service promoted caring, respectful and dignified relationships between people using the service and staff.

Care staff took care to provide personalised care but the care plans did not always reflect people’s full needs.

People were very well supported to maintain their hobbies and social interactions to minimise isolation.

The provider listened to concerns from stakeholders and responded by making improvements.

The atmosphere at the service was calm, open and happy. Staff morale was high and good communication was entrenched. The service was organised in a way that promoted safe care through effective quality monitoring.

We found two breaches of the regulations relating to medicine management and safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report. We have made a recommendation about monitoring food and fluid intake