This unannounced inspection was undertaken on 29 November 2017 and was carried out by one inspector. At our last comprehensive inspection in October 2016 the service was rated ‘Requires Improvement’. We undertook a focussed inspection of this service in April 2017 however the rating remained ‘Requires Improvement’. At this inspection the service was rated as ‘Good’.

Yad Voezer 1 is a ‘care home’ for men who have a learning disability. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates a maximum of 10 men. At the time of our inspection there were eight men living at the home. The home provides support in line with orthodox Jewish custom and practice.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was 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.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination.

Risks had been recorded in people’s care plans and ways to reduce these risks had been explored and were being followed appropriately.

People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received from the registered manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood the principles of the Mental Capacity Act (MCA 2005) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any healthcare needs people had. All food at the home was provided under Jewish laws, customs and practice.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences.

Everyone had an individual plan of care which was reviewed on a regular basis.

Relatives told us that the management and staff listened to them and acted on their suggestions and wishes.

People were supported to raise any concerns or complaints and relatives were happy to raise any issues with the registered manager if they needed to.

People, their relatives, staff and health and social care professionals were all included in monitoring the quality of the service. The registered manager and staff understood that observation was very important to identify people’s well-being where people did not always communicate verbally.

We carried out an unannounced comprehensive inspection of this service on 13 and 14 October 2016. Breaches of legal requirements were found regarding the safety of the premises and staff training. 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 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Yad Voezer 1 on our website at www.cqc.org.uk.

Yad Voezer 1 is a small care home which is registered to provide accommodation for up to 10 people with learning disabilities and people with autistic spectrum conditions. The service provides care for men in line with Orthodox Jewish practices. At the time of our inspection there were eight people using the service.

There was a 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.

At our last inspection we found that checks had identified dangerous flaws with the electrical system, and we could not be certain that these had been addressed. At this inspection we saw that these had been addressed and the electrical systems were certified as safe by a suitable contractor. The provider had measures in place for recording when important checks were carried out, however staff did not record whether these checks had identified actions and when the next check was due.

The provider had carried out fire drills and identified which people required support to evacuate the service, and had implemented personal evacuation plans for these people.

At our last inspection we found that the provider had not carried out an assessment of training needs for the service, and that some staff had not received appropriate training. At this inspection we found that the provider was still not meeting this requirement. Although the provider was arranging training for staff, only one session had taken place so far, and managers had not carried out an assessment of training needs for staff. We found that staff were receiving supervision regularly, although the provider did not have systems in place for ensuring that this continued.

We found that the provider was still in breach of regulations with regards to staff training. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this inspection over two days on 13 and 14 October 2016. This inspection was unannounced on the first day, and was carried out by a single inspector.

At our last inspection in December 2014 we found this provider was meeting the regulations, but made two recommendations about the maintenance of the building and the use of communication tools.

Yad Voezer 1 is a small care home which is registered to provide accommodation for up to 10 people with learning disabilities and people with autistic spectrum conditions. The service provides care for men in line with Orthodox Jewish practices. The building consists of 10 bedrooms over three floors, a large communal dining area and living room, kitchen, three bathrooms and staff office and sleeping in room. There is a large kitchen which is divided between dairy and meat sides in accordance with Kashrut law, and an additional Pesach kitchen upstairs to aid compliance with religious requirements at Passover which was closed at the time of our inspection. At the time of our inspection eight men were living in the service and one man was staying for respite.

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 service provided culturally appropriate support in a caring manner. There were tools in place to support people to express their views to staff and to consent to and make decisions about their care. Care plans clearly outlined people’s needs, preferences and wishes and contained information for staff about how to promote daily living skills and independence. Health action plans were in place to support people to maintain good health and people received extensive support from staff to attend appointments. People chose their own food and were consulted about the weekly menu. Where people were at risk of poor nutrition there were measures in place to monitor and mitigate this.

The provider had made considerable improvements to the building, including to the standard of cleaning, replacing worn carpets and refurbishing bathrooms, although one was still due to be refitted. There were still some outstanding maintenance issues, which were recorded by staff who liaised with the landlord to address these, however we found that important remedial work on electrical fittings had not been carried out.

There were detailed plans in place to manage risks to people who used the service. These included reviewing incidents and unusual occurrences to learn from events and to reduce people’s behaviour which may be unsafe. The provider had measures in place to promote a safe environment, including nightly and weekly checks of the premises. Where the provider stored money on behalf of people, there were not documented checks of this. Fire processes were in place, including an evacuation plan, checks of equipment and regular fire drills, although there were not personalised evacuation plans for people who needed staff support to evacuate. Medicines were safely managed and stored, and staff maintained accurate records of administration which were audited by senior staff and managers.

People benefitted from a stable staff team who had been in post for many years. Safer recruitment processes had been followed when staff were recruited. Staffing levels were adequate to meet people’s needs, and varied in response to activities, needs and festivals. Staff training records were incomplete, and some staff had not received recent training in areas including fire safety, food hygiene and infection control. Where supervisions and appraisals were carried out these were effective, however supervisions were not always carried out regularly. The provider’s policies did not st

The inspection visit took place on 9 December 2014. It was unannounced. At the last inspection in July 2014 we found a breach of the regulations in relation to staff support. On this occasion we found that appropriate steps had been taken to improve staff supervision and appraisal and all staff had started a programme of mandatory training to ensure they had up-to-date skills and knowledge.

The service provides care for eight men with a range of needs associated with learning disabilities and/or mental health issues. Some people have additional physical disabilities. There are two extra bedrooms available for men requiring short term respite care, but no one was using these rooms at the time of our inspection. Bedrooms are located on each of the three floors of the home. Each person has their own bedroom with wash hand basin. A stair-lift is available to the first floor. The service provides support in line with orthodox Jewish custom and practice.

A registered manager was 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 the time of our inspection, the registered manager was also covering for a vacant manager post at the provider’s nearby care home for women.

Some areas of the home required repairs and maintenance; whilst major faults had been attended to, smaller issues had not been attended to promptly. We have made a recommendation about this.

The home was tidy, but more attention needed to be given to cleaning hard to reach areas as well as items that were frequently touched such as light switches and chair arms. Some minor pieces of older equipment required replacement as they were hard to clean thoroughly.

Adaptations needed to be made to some of the written policies and procedures to ensure they reflected the particular circumstances of the home. New quality assessment and monitoring procedures had just been introduced. We were not sure that the arrangements in place to complete these tasks were sustainable in the long term so we have made a recommendation about this.

We found that staff had a detailed understanding of the people who used the service. Staff members were caring and respected people’s privacy, dignity and religious observances. People told us that the care staff were kind to them. There were some good examples of a thoughtful approach to decision making in line with the requirements of the Mental Capacity Act 2005 and the custom and practice of the orthodox Jewish faith.

There was evidence that medicines were safely administered, although one medicine was not stored appropriately.

Each person had an up-to-date care plan and associated risk assessments in place. These gave a clear picture of people’s needs and preferences. Some people needed more support with their communication in order to express their views. We made a recommendation about this.

People were provided with a choice of Kosher food, their evening meals were delivered by a restaurant. People regularly participated in activities they enjoyed, such as horse riding or bowling. They were supported to follow their faith by staff members and volunteers from the local community.

A single inspector carried out 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. The summary describes what people using the service, their relatives and the staff told us, what we observed, and the records we looked at. If you want to see evidence that supports our summary please read the full report.

We spoke with three people who used the service, the registered and deputy manager, three staff and five family members. Whilst we were able to speak with people, our conversations were limited because of their complex health conditions. We reviewed the care plans of three people.

This is a summary of what we found:

Is the service safe?

All family members told us they felt their family member was safe in the care of staff. Two of the 11 members of staff had received safeguarding and whistleblowing training in the last three years.

Systems were in place to ensure that staff learnt from events such as accidents and incidents. This reduced the risks to people.

During our inspection we assessed how the Mental Capacity Act (MCA) 2005 was being implemented. This is a law which provides a system of assessment and decision making to protect people who do not have capacity to give consent. We also looked at Deprivation of Liberty Safeguards (DoLS). DoLS aim to make sure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. We saw that some people were unable to leave the home without the assistance of staff. This may mean deprivation of liberty authorisations were required. We saw one application for a DoL which had been authorised.

People and their family members told us that their dignity was respected.

Is the service effective?

We observed from speaking with staff and watching how they communicated with people that staff had an understanding of people’s care and support needs and knew them well.

Staff assessed people’s health and care needs with the person and their family members. Staff told us care plans assisted them to meet people's needs. We saw information in care plans included risk assessments and these were sufficiently detailed to guide staff.

We saw that not all staff received regular supervision or appraisals. We have asked the provider to tell us how they will make improvements and meet the legal requirements in relation to supporting staff.

Is the service caring?

Care workers showed patience and gave encouragement when supporting people. One person said, “Staff are helpful,” another said they were, “Fine.” A third person said they (the staff) were, “Very kind.” One family member said, "Staff are very helpful and caring.” Another family member said they were, “Happy with staff.”

People's preferences, interests and diverse needs were recorded, and care and support was provided in accordance with the wishes of people using the service and their families.

Is the service responsive?

People took part in activities within the home and the wider community.

All family members told us they knew how to make a complaint. We saw there was a process in place to respond to any issues of concern.

Is the service well-led?

This service has quality assurance systems to identify and address issues. All members of staff we spoke with were clear about their roles and responsibilities.

We found that the provider had taken action to improve the quality and safety of care since our last inspection. The home had addressed the concerns we raised at that time.

At this inspection, we saw that the staff had reviewed people's care plans and were now assessing and managing risks to people's health and wellbeing in discussion with people using the service, their families and relevant professionals.

The home's systems for managing medicines had been reviewed and improved. The staff were monitoring the stock of medicines in the home, storing medicines safely and checking that medicines were within their expiry dates. Staff checked the administration of medicines at every handover.

We found that the environment of the home had been improved. People's rooms had been redecorated and the provider had secured the landlord's agreement to proceed with improvement work to the downstairs communal areas. Yad Voezer 1 was providing a suitably homely environment for people using the service.

Five people were at home on the day of the inspection. Some people were able to speak with us and indicated they were happy in the home.

We saw that staff interactions with people were caring and promoted people's choices. Staff working in the home respected people's privacy and independence. People were able to ask staff members for support when they needed it and we saw staff responding positively. Staff members knew how to support people in line with Jewish Orthodox culture and customs. Members of staff were positive about the home and felt they were well trained and well supported by the manager.

However we found some areas that needed improvement. Staff did not always have detailed information about how to support people and manage risks to individuals’ wellbeing. Medicines management in the home was not being monitored effectively. The provider had not yet implemented planned improvements to the premises. We noted however that some redecoration and improvement work was planned.

We received some feedback from people who used services, although it was limited due to their level of learning disabilities. Those service users who spoke with us told us or used gestures and body languae to indicate that they were happy in the home.