We carried out an unannounced inspection of this service on 11 and 12 December 2018. Vi and John Rubens House provides accommodation and nursing care and can support up to 105 older people. The service is run by Jewish Care, a voluntary organisation. At the time of our inspection 83 people were living at the service.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. This service provides personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service has a registered manager in post. 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.

At our last inspection on 19 May 2016 the service was rated ‘Good'. At this inspection we found that this service continued to be ‘Good.’

Safeguarding procedures were in place and staff had a clear understanding of how to report abuse and protect people from harm. A recommendation was made to review best practice guidelines and ensure policies were updated to ensure staff knew how to keep people safe. Risk assessments were in place and gave details about how to support people in a safe way. Staff were recruited in a safe manner. Staffing levels were sufficient, so the service could meet people's needs. Medicines were administered and managed safely. We made a recommendation to review best practice guidelines and ensure policies guide staff to manage medicines in a safe way. Infection control was being managed to prevent the spread of infection. Accidents and incidents were recorded and lessons were learnt to improve the running of the service.

The service had been designed and adapted with people’s support needs in mind. Pre-admission assessments had been completed for all people to ensure their needs could be met. Staff received a detailed induction to the service and ongoing training to allow them to provide effective care and support to people. Staff felt supported and received regular supervisions and an annual appraisal. People spoke positively about mealtimes and the service worked well with other health and social care teams to ensure people were supported to stay healthy and well. Staff understood the Mental Capacity Act 2005 (MCA). The MCA is a law protecting people who are unable to make decisions for themselves. Where people did not have the capacity to consent to their care and support, the appropriate applications had been made.

Staff were kind and respectful and knew how to communicate with people with different support needs. Staff demonstrated an understanding around equality and diversity. People and their relatives were fully involved in their care and support provided. Staff maintained people's privacy and dignity and the service promoted people to be as independent as possible.

People received personalised support and each person had an up to date care plan. People were encouraged to engage in activities. However, we did not see evidence of sufficient activities available for people who were in their bedroom. A recommendation was made to follow best practice guidelines and ensure all people felt they had an opportunity to participate in meaningful activities. People and their relatives felt comfortable raising complaints and all complaints were appropriately responded to. The service provided end of life care that took into consideration individual wishes.

People, relatives and staff spoke positively about the registered manager. The service gathered feedback from people, relatives and staff. This service completed quality checks to ensure the service was always improving the quality of care provided.

This inspection took place over two days on 19 and 23 May 2016 and was unannounced on the first day.

The service is registered to provide residential and nursing care and support to 105 older people. The service is run by Jewish Care, a voluntary organisation. On the day of this inspection, 92 people were using the service. The nursing and residential services are located on the ground floor and upstairs, there are two units for people living with dementia.

At our previous inspection in June 2014 the service was compliant with the regulations we inspected.

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.

People told us they felt safe in the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received recent training in safeguarding adults. Staff were aware of the actions they needed to take if they had concerns regarding people's safety.

Risks to people's health and wellbeing were identified, recorded, reviewed and managed. Systems were in place to ensure that people received their prescribed medicines safely and appropriately.

The provider’s recruitment process ensured that staff were suitable to work with people who needed support.

Staffing levels were sufficient to meet people’s needs. Systems were in place to review staffing levels in line with people’s needs.

Staff received regular training and supervision that provided them with the knowledge and skills to meet people's needs. The provider was in the process of incorporating annual staff appraisals as part of their staff support process.

Staff supported people to make choices about their care. Systems were in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and that their human rights were protected.

People living with dementia were accommodated in two separate units on the second floor. We saw that the environment was not suitably adapted to meet their needs and we have made a recommendation about this.

People told us that they were happy with the food and drink and were provided with culturally appropriate food of their choice so that their nutritional needs were met.

Staff had a good knowledge of people’s life histories and preferences regarding their care and support needs. People’s care plans were being reviewed and updated to ensure that they contained all of the necessary information to enable staff to support them safely.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

Sufficient arrangements were not in place to meet people's social and recreational needs and we have made a recommendation about this.

The registered manager was aware of the requirements of their registration with us and notified us of significant events related to care provision. The registered manager regularly assessed and monitored the quality of care to ensure standards were met and maintained.

The inspector was accompanied by an expert by experience at this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led.

Below is a summary of what we found.

Is the service safe?

People told us they felt safe living at the home and that staff treated them well. One person said "I’m very comfortable here with the pleasant personnel and the pleasant treatment. I’m not going to change anything.”

People’s files included relevant risk assessments for each individual, indicating the risks to the person and how these could be minimised to ensure that they were supported as safely as possible. Before people were admitted to the home, arrangements were in place to make sure they would be safe in their environment and that staff had the skills and experience to meet their needs.

We found that people were cared for in safe and accessible surroundings that supported their health and welfare. We spoke with the registered manager during our inspection as we observed that some areas of the home were in need of re-decoration. We also noted some furniture was in need of replacement. We were informed that major refurbishment work to the home was due to commence by the end of 2014.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People's health and care needs were assessed with them and their relatives if appropriate. Visiting relatives said “ they do an amazing job.” People, and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary requirements, mobility and equipment needs had been identified in care plans where required.

We looked at people's care records which showed that care plans set out people's individual care needs. They were current and the records showed they had been reviewed on a regular basis and adjustments had been made when a person's care needs changed. During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when they supported people. A person we spoke to said “it’s a happy place to be. They look after us well.” People who used the service, their relatives and friends completed a satisfaction survey annually and their views were also sought at quarterly meetings. Where concerns or comments were raised these had been addressed and an action plan was in place. People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Records showed people had access to a range of healthcare professionals some of whom visited people at the home. These included GPs, district nurses, dieticians and a chiropodist.

Is the service responsive?

Staff we spoke to were knowledgeable about the needs of people they supported and how to meet them. Care plans included information about people's preferred routines, religious and cultural needs, healthcare needs as well as their likes and dislikes. This ensured that people received an individualised service. Care plans were reviewed and updated monthly or when people's needs had changed. People were supported to access a range of healthcare professionals to promote their wellbeing. Senior staff referred people to appropriate professionals for assessment and advice. Any actions advised by them were implemented by staff.

Is the service well-led?

The service had a quality assurance process in place. Sufficient systems were in place to monitor the quality of the service provided to ensure that people received safe, quality care. Annual customer satisfaction questionnaires were sent to people and their representatives to seek their views and opinions about the service in order to find out where improvements were needed. Staff told us they were clear about their roles and responsibilities. They were supported by the management team to provide good, quality care and were encouraged to complete relevant training. People knew how to make a complaint if they were unhappy. Relatives and people's views were also sought at meetings which were held quarterly. We found a number of audits were undertaken by staff, the manager and by the registered provider to ensure that people received safe, quality care.

People told us that the service was able to meet their care needs. One person said "they look after me. They do everything they need to do." We found that person centred care plans were in place. These clearly set out how to meet people's individual needs. People had access to health care professionals.

People told us that they felt safe at the service, and they knew who they could talk to if they had any concerns. One person replied "oh definitely" when asked if they felt safe. We found staff had a good understanding of their responsibilities with regard to safeguarding vulnerable adults. Robust staff recruitment procedures were in place to help ensure suitable staff were employed to work at the service.

People told us they were happy with the home's physical environment. People said they were able to personalise their rooms, one person said they were "able to put my own art up on the walls." We found checks had been carried out to help ensure the environment was safe, such as checks on the fire alarm system.

We found that medications were stored securely, and mostly administered correctly. However, improvements could be made in the recording of medications that were disposed of by the service.

People told us they were treated with respect and dignity, and that they could make choices over their daily lives. One person said "I choose my own clothes to wear" and "I go to bed when I want." We observed that people were able to make choices and that staff interacted with them in a respectful manner for the most part. Care plans were in place for people, and these had being developed with the involvement of people and their relatives. Records showed that people had access to health care professionals including GP's and opticians. People told us they were provided with sufficient amounts of food and drink to meet their needs. One person told us "you do get enough to eat." Some people said they liked the food, others that they didn't like it. Comments included "the food is nice, I can’t complain" and "the food varies quite a bit. Sometimes it is not as good as it should be." We saw that people were provided with a choice of meals, and support was provided with eating where needed.

People told us they knew how to make a complaint. One person told us "if anything is wrong you go to Mary (the manager), she listens to you." We saw that the service had a complaints procedure in place, and that complaints were properly investigated. We saw that checks had being made on staff before they started working at the service, including proof of identification and Criminal Records Bureau checks. However, we saw that employment references were not properly checked by the service.

People who use the service told us that “staff are approachable” and that the “nursing care was wonderful”. Relatives and visitors were positive about the care and treatment provided and felt that they were made welcome when they visited the home. They welcome being able to visit at any time. Staff told us that they can access training of good quality and were generally well supported at work. A current issue with the food was described to us as well as the ongoing work to improve this.